SynthesisNeurosurgery2020
Outcome After Decompressive Craniectomy for Middle Cerebral Artery Infarction: Timing of the Intervention.
Synthesis in Neurosurgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature.World journal of emergency surgery : WJES · 2020Pooled it
- Stereotactic Aspiration Acts as an Effective Treatment for Malignant Middle Cerebral Artery Infarction.Journal of healthcare engineering · 2022Trial
- Factors associated with mortality and functional outcome after decompressive craniectomy in malignant middle cerebral artery infarction.BMC neurology · 2024Article
- Surgical timing and indications for decompressive craniectomy in malignant stroke: results from a single-center retrospective analysis.Acta neurochirurgica · 2023Article
- Outcome and management of decompressive hemicraniectomy in malignant hemispheric stroke following cardiothoracic surgery.Scientific reports · 2023Observational
- Article
- Decompressive craniectomy is a life-saving procedure in malignant MCA infarction.Neurosciences (Riyadh, Saudi Arabia) · 2021Article
- Risk Factors for Cerebral Infarction After Moderate or Severe Traumatic Brain Injury.Therapeutics and clinical risk management · 2021Article
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBased on randomized controlled trials (RCTs), clinical guidelines for the treatment of space-occupying hemispheric infarct employ age (≤60 yr) and time elapsed since stroke onset (≤48 h) as decisive criteria whether to perform decompressive craniectomy (DC). However, only few patients in these RCTs underwent DC after 48 h.
objectiveTo study the association between the timing of DC and (un)favorable outcome in patients with space-occupying middle cerebral artery (MCA) infarct undergoing DC.
methodsWe performed a single-center cohort study from 2007 to 2017. Unfavorable outcome at 1 yr was defined as a Glasgow outcome scale 1 to 3. Additionally, we systematically reviewed the literature up to November 2018, including studies reporting on the timing of DC and other predictors of outcome. We performed Firth penalized likelihood and random-effects meta-analysis with odds ratio (OR) on unfavorable outcome.
resultsA total of 66 patients were enrolled. A total of 26 (39%) patients achieved favorable and 40 (61%) unfavorable outcomes (13 [20%] died). DC after 48 h since stroke diagnosis did not significantly increase the risk of unfavorable outcome (OR 0.8, 95% CI 0.3-2.3). Also, in the meta-analysis, DC after 48 h of stroke onset was not associated with a higher risk of unfavorable outcome (OR 1.11; 95% CI 0.89-1.38).
conclusionThe outcome of DC performed after 48 h in patients with malignant MCA infarct was not worse than the outcome of DC performed within 48 h. Contrary to current guidelines, we, therefore, advocate not to set a restriction of ≤48 h on the time elapsed since stroke onset in the decision whether to perform DC.
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