Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate
Table 1
Demographic, clinical, radiological imaging, and surgical data in relation to the time of surgery.
Factors
Total
HCN ≤ 48 (, 39.4%)
HCN > 48 (, 60.6%)
value
Age in years
47.8 ± 11.0
47.8 ± 10.6
47.9 ± 11.3
0.966
<55 years
104 (75.9)
41 (75.9)
63 (75.9)
0.998
≥55 years
33 (24.1)
13 (24.1)
20 (24.1)
Gender
Male
111 (81.0)
41 (75.9)
70 (84.3)
0.220
Female
26 (19.0)
13 (24.1)
13 (15.7)
Hypertension
63 (46.0)
24 (44.4)
39 (47.0)
0.770
Diabetes
47 (34.3)
22 (40.7)
25 (30.1)
0.201
Dyslipidemia
50 (36.5)
22 (40.7)
28 (33.7)
0.405
Coronary artery disease
30 (21.9)
10 (18.5)
20 (24.1)
0.440
Affected side
Left
64 (46.7)
25 (46.3)
39 (47.0)
0.937
Right
73 (53.3)
29 (53.7)
44 (53.0)
Herniation time (from onset)
<24 hours
29 (21.2)
25 (46.3)
4 (4.8)
<0.001
24–<48 hours
51 (37.2)
29 (53.7)
22 (26.5)
48–<72 hours
30 (21.9)
0
30 (36.1)
≥72 hours
27 (19.7)
0
27 (32.5)
GCS at herniation
7.57 ± 2.36
7.6 ± 2.5
7.6 ± 2.3
0.957
Pupillary abnormality
27 (19.7)
10 (18.5)
17 (20.5)
0.778
Bilateral Babinski
83 (60.6)
34 (63.0)
49 (59.0)
0.646
Comatose
83 (60.6)
32 (59.3)
51 (61.4)
0.798
Uncal herniation
92 (67.2)
43 (79.6)
49 (59.0)
0.012
Mean time of first CT
7.71 ± 8.6
6.4 ± 7.5
8.5 ± 9.2
0.293
Mean time of second CT
45.15 ± 40.7
25.8 ± 10.1
57.3 ± 47.5
<0.001
Mean CT time for maximum infarct volume
58.1 ± 55.78
28.9 ± 13.4
76.9 ± 64.2
<0.001
Mean infarct volume on 1st CT
117.4 ± 108.5
123.1 ± 114.6
113.7 ± 104.9
0.624
Mean infarct volume on 2nd CT
325.1 ± 131.5
349.5 ± 130.1
309.8 ± 130.9
0.094
Maximum infarct volume (cm3)
367.7 ± 119.4
371.8 ± 125.3
365.0 ± 116.2
0.747
Infarct growth rate 1 (ml/hr)
10.3 ± 7.5
15.2 ± 8.1
7.1 ± 5.03
<0.001
Infarct growth rate 2 (ml/hr)
9.7 ± 7.9
13.6 ± 8.7
7.2 ± 6.2
<0.001
Type of MCA infarction
Without additional infarct
80 (58.4)
24 (44.4)
56 (67.5)
0.008
With additional infarct
57 (41.6)
30 (55.6)
27 (32.5)
Temporal lobe involved
86 (62.8)
41 (75.9)
45 (54.2)
0.010
SP displacement (last CT)
1.01 ± 0.37
0.89 ± 0.38
1.1 ± 0.35
0.003
>1 cm
81 (59.1)
26 (48.1)
55 (66.3)
0.035
≤1 cm
56 (40.9)
28 (51.9)
28 (33.7)
Vascular occlusion present
114 (83.2)
46 (85.2)
68 (81.9)
0.618
Type of vessel occluded
MCA
81 (71.1)
27 (58.7)
54 (79.4)
0.056
MCA/ACA
12 (10.5)
7 (15.2)
5 (7.4)
ICA/MCA/ACA
21 (18.4)
12 (26.1)
9 (13.2)
Prognosis at 90 days
MRS 0–4
84 (61.3)
29 (53.7)
55 (66.3)
0.140
MRS 5-6
53 (38.7)
25 (46.3)
28 (33.7)
value has been measured using Mann–Whitney test. Results are expressed as mean ± standard deviation, median (interquartile range), and number (percentage). value has been calculated using binary logistic regression Wald test. CT, computer tomography; SP, septum pellucidum; MIV, maximum infarct volume; cm3, cubic centimeters.
