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Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results

Salvatore Massimiliano Cardali, Maria Caffo, Gerardo Caruso, Gianluca Scalia, Nicola Gorgoglione, Alfredo Conti, Sergio Lucio Vinci, Valeria Barresi, Francesca Granata, Giuseppe Ricciardo, Giada Garufi, Giovanni Raffa, Antonino Germanò
DOI: 10.1136/svn-2021-000918 Published 20 December 2022
Salvatore Massimiliano Cardali
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Maria Caffo
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Gerardo Caruso
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Gianluca Scalia
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Nicola Gorgoglione
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Alfredo Conti
2 Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Sergio Lucio Vinci
3 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neuroradiology, University of Messina, Messina, Italy
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Valeria Barresi
4 Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona, Verona, Italy
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Francesca Granata
3 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neuroradiology, University of Messina, Messina, Italy
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Giuseppe Ricciardo
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Giada Garufi
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Giovanni Raffa
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Antonino Germanò
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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    Figure 1

    The diffusion-weighted MRI study shows hyperintensity from left middle cerebral artery infarction with a volume of 155 cm3 of ischaemic area.

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    Figure 2

    Intraoperative images of cisternotomy: (A) opening of olfactory cistern, (B) and of chiasmatic cistern. (C) Opening of ipsilateral optic-carotid cistern, (D) and of controlateral optic-carotid cistern.

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    Figure 3

    MRI study with angiographic sequences demonstrates the lack of visualisation of the left middle cerebral artery.

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    Figure 4

    The MRI study (axial view) with angiographic sequences 1 month after the surgical treatment demonstrates the recanalisation of the left MCA.

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    Figure 5

    CT scan (axial view) performed in the immediate postoperative period shows a shift of more than 8 mm.

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    Figure 6

    Schematic representation of the pathophysiology of brain oedema in acute ischaemic stroke and its decrease after cisternostomy.

Tables

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  • Table 1

    Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS) score at admission and before surgical treatment; the GCS, the NIHSS score and the modified Rankin Scale (mRS) score recorded at discharge, and at 3, 6 and 9 months

    GCSNIHSSmRS
    Admission11.2±1.3814.5±3.47–
    Before surgery8.21±1.3122±1.41–
    Discharge9.14±0.9419.2±1.724.35±0.47
    Three months10±1.0716±2.014±0.53
    Six months10.5±1.2215.4±1.843.78±0.55
    Nine months11.2±1.4713.4±2.133.42±0.62
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Vol 7 Issue 6 Table of Contents
Stroke and Vascular Neurology: 7 (6)
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Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results
Salvatore Massimiliano Cardali, Maria Caffo, Gerardo Caruso, Gianluca Scalia, Nicola Gorgoglione, Alfredo Conti, Sergio Lucio Vinci, Valeria Barresi, Francesca Granata, Giuseppe Ricciardo, Giada Garufi, Giovanni Raffa, Antonino Germanò
Stroke and Vascular Neurology Dec 2022, 7 (6) 476-481; DOI: 10.1136/svn-2021-000918

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Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results
Salvatore Massimiliano Cardali, Maria Caffo, Gerardo Caruso, Gianluca Scalia, Nicola Gorgoglione, Alfredo Conti, Sergio Lucio Vinci, Valeria Barresi, Francesca Granata, Giuseppe Ricciardo, Giada Garufi, Giovanni Raffa, Antonino Germanò
Stroke and Vascular Neurology Dec 2022, 7 (6) 476-481; DOI: 10.1136/svn-2021-000918
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Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results
Salvatore Massimiliano Cardali, Maria Caffo, Gerardo Caruso, Gianluca Scalia, Nicola Gorgoglione, Alfredo Conti, Sergio Lucio Vinci, Valeria Barresi, Francesca Granata, Giuseppe Ricciardo, Giada Garufi, Giovanni Raffa, Antonino Germanò
Stroke and Vascular Neurology Dec 2022, 7 (6) 476-481; DOI: 10.1136/svn-2021-000918
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