Decompressive craniectomy for hemispheric infarction: Predictive factors for six month rehabilitation outcome

Abstract

Background Decompressive craniectomy after hemispheric infarction has been shown to reduce mortality and functional outcome in selected patients. However, the optimal timing for surgery and patient most likely to benefit from this procedures was not known. We aimed to determine possible factors predictive of outcome following decompressive craniectomy for ischemic infarction from review of oneuro-logical outcome in our patients at six months. Methods We retrospectively reviewed 21 patients who underwent decompressive craniectomy for hemispheric infarction over a three year period in a regional neurosurgical center in Hong Kong. All patients were recruited subsequently for active in-patient rehabilitation, when suitable. Findings The median age was 53 and the male to female ration was 1:3. Four patients (19%) achieved independent activity of daily living at six months after rehabilitation. Neither early surgery, within 24-48 hours after admission, nor side of infarction correlated with six month neurological outcome. All four patients with favourable neurological outcome at six month demonstrated favourable clinical improvement even at one month. Conclusions Early decompressive hemicraniectomy is not predictive of neurological outcome, determined by Glasgow outcome score, at six months (P=1.00, NS). © 2008 Springer-Verlag/Wien.