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DOI: 10.1055/s-0042-1756142
Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution
Craniectomia descompressiva no acidente vascular cerebral isquêmico extenso. Uma experiência em uma única instituição![](https://www.thieme-connect.de/media/10.1055-s-00028832/202401/lookinside/thumbnails/10-1055-s-0042-1756142_2000056-1.jpg)
Abstract
Introduction Decompressive craniectomy (DC) is a valuable treatment for reducing early lethality in malignant intracranial hypertension (IH); however, it has been shown that the decision to implement DC in patients with extensive ischemic stroke should not be based solely on the detection of IH with the use of intracranial pressure (ICP) devices.
Objective To establish the usefulness of DC in patients with extensive ischemic stroke who came to the emergency room during the period between May 2018 and March 2019.
Methods This was an analytical, prospective, and longitudinal study whose population corresponded to all patients with a diagnosis of extensive ischemic stroke.
Results The sample consisted of 5 patients, of which 3 were female and 2 males, the average age was 62.2 years old (minimum 49 years old, maximum 77 years old). Of all the patients who underwent DC, it was found that 80% of the patients did not present an increase in intracranial pressure. Decompressive craniectomy was not performed in a case that responded adequately to medical treatment. The mean values of ICP were 25 mmHg with a minimum value of 20 mmHg and a maximum value of 25 mmHg; in patients with a moderate value, the ICP averages were < 20 mmHg. The mortality was of 40% (RANKIN of 6 points).
Conclusions Decompressive craniectomy is useful in extensive ischemic stroke. The decision to implement DC in patients with extensive stroke rests on clinicoradiological parameters. The monitoring of the IPC was not particularly useful in the early detection of the neurological deterioration of the patients studied.
Resumo
Fundamento A craniectomia descompressiva (CD) é um tratamento valioso para reduzir a letalidade precoce na hipertensão intracraniana (HI) maligna; no entanto, foi demonstrado que a decisão de implementar a CD em pacientes com acidente vascular cerebral (AVC) isquêmico extenso não deve ser baseada apenas na detecção de HI com o uso de dispositivos de pressão intracraniana (PIC).
Objetivo Estabelecer a utilidade da CD em pacientes com AVC isquêmico extenso que chegaram ao pronto-socorro no período entre maio de 2018 e março de 2019.
Métodos Foi realizado um estudo analítico, prospectivo e longitudinal cuja população correspondeu a todos os pacientes com diagnóstico de AVC isquêmico extenso.
Resultados A amostra foi composta por 5 pacientes, sendo 3 do sexo feminino e 2 do sexo masculino, com média de idade de 62,2 anos (mínimo 49 anos, máximo 77 anos). De todos os pacientes que realizaram CD, verificou-se que 80% dos pacientes não apresentaram aumento da pressão intracraniana. Não foi realizada uma CD que tenha respondido adequadamente ao tratamento médico. Os valores médios de pressão intracraniana foram de 25 mmHg, com o valor mínimo de 20 mmHg e o valor máximo de 25 mmHg; em pacientes com escala moderada, as médias de PIC foram < 20 mm Hg. A mortalidade foi de 40% (RANKIN de 6 pontos).
Conclusões A DC é útil no AVC isquêmico extenso. A decisão de implementar uma CD em pacientes com AVC extenso depende de parâmetros clínico-radiológicos. O monitoramento do PCI não foi muito útil na detecção precoce da deterioração neurológica dos pacientes estudados.
Keywords
decompressive craniectomy - intracranial hypertension - intracranial pressure - ischemic strokePalavras-chave
craniectomia descompressiva - hipertensão intracraniana - pressão intracraniana - acidente vascular cerebral isquêmicoPublication History
Received: 29 May 2020
Accepted: 21 June 2022
Article published online:
18 October 2023
© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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