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Subcortical Sparing Associated with Ambulatory Independence after Hemicraniectomy for Malignant Infarction

      Decompressive hemicraniectomy (DHC) is a life-saving
      • Vahedi K.
      • Hofmeijer J.
      • Juettler E.
      • et al.
      Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials.
      and function-sparing
      • Reinink H.
      • Juttler E.
      • Hacke W.
      • et al.
      Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials.
      procedure for patients with malignant middle cerebral artery (MCA) infarction. Pooled estimates suggest that approximately 40% of patients achieve ambulatory independence after DHC,
      • Vahedi K.
      • Hofmeijer J.
      • Juettler E.
      • et al.
      Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials.
      ,
      • Reinink H.
      • Juttler E.
      • Hacke W.
      • et al.
      Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials.
      with age
      • Juttler E.
      • Unterberg A.
      • Woitzik J.
      • et al.
      Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke.
      being the only clinical or radiologic feature found to influence the likelihood of achieving this outcome.
      • Reinink H.
      • Juttler E.
      • Hacke W.
      • et al.
      Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials.
      Subcortical infarctions have been shown to impair motor recovery and gait,
      • Jones P.S.
      • Pomeroy V.M.
      • Wang J.
      • et al.
      Does stroke location predict walk speed response to gait rehabilitation?.
      ,
      • Zhu L.L.
      • Lindenberg R.
      • Alexander M.P.
      • Schlaug G.
      Lesion load of the corticospinal tract predicts motor impairment in chronic stroke.
      but whether the presence of a subcortical infarction affects functional outcome following DHC remains unknown. Our aim was to determine if subcortical involvement in malignant MCA infarction is associated with independent ambulation one year following DHC.
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