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Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery
Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated wh...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233335/ https://www.ncbi.nlm.nih.gov/pubmed/25400113 http://dx.doi.org/10.1038/srep07070 |
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author | Lu, XiaoCheng Huang, BaoSheng Zheng, JinYu Tao, Yi Yu, Wan Tang, LinJun Zhu, RongLan Li, Shuai Li, LiXin |
author_facet | Lu, XiaoCheng Huang, BaoSheng Zheng, JinYu Tao, Yi Yu, Wan Tang, LinJun Zhu, RongLan Li, Shuai Li, LiXin |
author_sort | Lu, XiaoCheng |
collection | PubMed |
description | Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction. |
format | Online Article Text |
id | pubmed-4233335 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Nature Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-42333352014-11-21 Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery Lu, XiaoCheng Huang, BaoSheng Zheng, JinYu Tao, Yi Yu, Wan Tang, LinJun Zhu, RongLan Li, Shuai Li, LiXin Sci Rep Article Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction. Nature Publishing Group 2014-11-17 /pmc/articles/PMC4233335/ /pubmed/25400113 http://dx.doi.org/10.1038/srep07070 Text en Copyright © 2014, Macmillan Publishers Limited. All rights reserved http://creativecommons.org/licenses/by-nc-sa/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder in order to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ |
spellingShingle | Article Lu, XiaoCheng Huang, BaoSheng Zheng, JinYu Tao, Yi Yu, Wan Tang, LinJun Zhu, RongLan Li, Shuai Li, LiXin Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title | Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title_full | Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title_fullStr | Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title_full_unstemmed | Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title_short | Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
title_sort | decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233335/ https://www.ncbi.nlm.nih.gov/pubmed/25400113 http://dx.doi.org/10.1038/srep07070 |
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