Evidence map›Paper›PMID 37162579›Full record

Trial reportJournal of neurology2023

Large diameter hemicraniectomy does not improve long-term outcome in malignant infarction.

Dominik Lehrieder, Hans-Peter Müller, Jan Kassubek, Nils Hecht, Götz Thomalla, Dominik Michalski, Thomas Gattringer, Katja E Wartenberg, Jörg Schultze-Amberger, Hagen Huttner and 13 more

Open access · hybridAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.9field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 19 institutions in 2 countries.

Dominik LehriederDepartment of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany. Lehrieder_D@ukw.de.ORCID http://orcid.org/0000-0002-2339-8598
Hans-Peter MüllerDepartment of Neurology, University Hospital Ulm, Ulm, Germany.
Jan KassubekDepartment of Neurology, University Hospital Ulm, Ulm, Germany.
Nils HechtDepartment of Neurosurgery and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Götz ThomallaDepartment of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dominik MichalskiDepartment of Neurology, University Hospital Leipzig, Leipzig, Germany.
Thomas GattringerDepartment of Neurology, Medical University of Graz, Graz, Austria.
Katja E WartenbergDepartment of Neurology, University Hospital Leipzig, Leipzig, Germany.
Jörg Schultze-AmbergerDepartment of Neurology, Klinikum Ernst Von Bergmann Potsdam, Potsdam, Germany.
Hagen HuttnerDepartment of Neurology, University Hospital Giessen, Giessen, Germany.
Joji B KuramatsuDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Silke WunderlichDepartment of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Hans-Herbert SteinerDepartment of Neurosurgery, Paracelsus Medical University, Nuernberg, Germany.
Karin WeissenbornDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Suzette HeckDepartment of Neurology, University of Munich, Ludwig Maximilian University, Munich, Germany.
Albrecht GüntherDepartment of Neurology, University Hospital Jena, Jena, Germany.
Hauke SchneiderDepartment of Neurology, University Hospital Dresden, Dresden, Germany.
Sven PoliDepartment of Neurology and Stroke, Eberhard-Karls University Tuebingen, Tuebingen, Germany.
Christian DohmenDepartment of Neurology, University Hospital Cologne, Cologne, Germany.
Johannes WoitzikDepartment of Neurosurgery, University Hospital Oldenburg, Oldenburg, Germany.
Eric JüttlerDepartment of Neurology, Ostalb-Klinikum Aalen, Aalen, Germany.
Hermann NeugebauerDepartment of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
DESTINY-R (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY - Registry) Study Group and IGNITE (Initiative of German NeuroIntensive Trial Engagement) Study Group
University Hospital Leipzig · DEUniversity Hospital Ulm · DEHertie Institute for Clinical Brain Research · DEHumboldt-Universität zu Berlin · DEJena University Hospital · DEKlinikum Ernst von Bergmann · DELudwig-Maximilians-Universität München · DELVR-Klinik Bonn · DEMedical University of Graz · ATMedizinische Hochschule Hannover · DEOstalb-Klinikum Aalen · DEParacelsus Medizinische Privatuniversität · DETUM Klinikum · DEUniversität Hamburg · DEUniversitäts-Kinderklinik Würzburg · DEUniversitätsklinikum Erlangen · DEUniversitätsklinikum Gießen und Marburg · DEUniversitätsklinikum Würzburg · DEUniversity Hospital Augsburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14 cm (HC > 14). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14 cm (HC ≤ 14).

methodsPatients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.

resultsAmong 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.

conclusionIn this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy. CLINICAL TRIAL REGISTRATION INFORMATION: German Clinical Trials Register (URL: https://www.drks.de ; Unique Identifier: DRKS00000624).

Indexed as

Decompressive CraniectomyInfarction, Middle Cerebral ArteryFemaleHospital MortalityHumansMaleMiddle AgedSeverity of Illness IndexTreatment OutcomeFunctional outcomeHemicraniectomyMalignant strokeMiddle cerebral artery infarctionSize of hemicraniectomy

Identifiers

PMID37162579
PMCPMC10345046
OpenAlexW4376121655

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.