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In patients with massive hemispheric infarctions, mortality exceeds 80% with medical
therapy alone. In certain conditions hemicraniectomy may result in meaningful survival.
We studied presurgical clinical and electrophysiological parameters that may serve
as prognostic factors to assess efficacy of decompressive surgery. We evaluated 26
consecutive patients with severe focal neurological deficit, deterioration of consciousness,
and massive hemispheric infarction by cranial computerized tomography who underwent
hemicraniectomy. Clinical examination included pupillary size and reaction, and determination
of level of consciousness on an hourly basis. Median nerve somatosensory evoked potentials
and brainstem auditory evoked potentials were obtained before and after hemicraniectomy.
Outcome was assessed by using the Barthel Index. Clinical and evoked potential data
were correlated with the outcome. Fisher's Exact Test was applied to establish statistical
significance. With surgery 18 of 26 patients survived on an average intensive care
treatment of 29.6 (±27.5) days. Barthel Index at discharge was 61.7 (±24.4) in survivors.
Presurgical pupillary reaction, level of consciousness, and somatosensory evoked potentials
were not found to correlate with outcome. In contrast, presurgical brainstem auditory
evoked potentials showed a significant correlation with survival (P<.05). All patients with good outcomes (Barthel Index ≥60: n=12, 46.1%) had normal
brainstem auditory evoked potentials before surgery. Clinical parameters did not reliably
forecast prognosis in patients with massive cerebral infarction treated with hemicraniectomy
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Article info
Publication history
Accepted:
August 11,
1997
Received:
May 28,
1997
Footnotes
†Supported in part by Grant Ha 1394/3-2 from the Deutsche Forschuugsgemeinschorft.
Identification
Copyright
© 1998 National Stroke Association. Published by Elsevier Inc.
