RT Journal Article
SR Electronic
T1 Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 476
OP 481
DO 10.1136/svn-2021-000918
VO 7
IS 6
A1 Cardali, Salvatore Massimiliano
A1 Caffo, Maria
A1 Caruso, Gerardo
A1 Scalia, Gianluca
A1 Gorgoglione, Nicola
A1 Conti, Alfredo
A1 Vinci, Sergio Lucio
A1 Barresi, Valeria
A1 Granata, Francesca
A1 Ricciardo, Giuseppe
A1 Garufi, Giada
A1 Raffa, Giovanni
A1 Germanò, Antonino
YR 2022
UL http://svn.bmj.com/content/7/6/476.abstract
AB Background The ischaemic stroke of the territory of the middle cerebral artery represents an event burdened by high mortality and severe morbidity. The proposed medical treatments do not always prove effective. Decompressive craniectomy allows the ischaemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. In this study, we propose a novel treatment for these patients characterised by surgical fenestration of the cisterns of the skull base.Methods We have treated 16 patients affected by malignant middle cerebral artery ischaemia and treated with cisternostomy between August 2018 and December 2019. The clinical history, neurological examination findings and neuroradiological studies (brain CT, CT angiography, MRI) were performed to diagnose stroke. Clinical examination was recorded on admission and preoperatively using the Glasgow Coma Scale and the National Institutes of Health Stroke Scale.Results The study included 16 patients, 10 males and 6 females. The mean age at surgery was 60.1 years (range 19–73). Surgical procedure was performed in all patients. The patients underwent immediate postoperative CT scan and were in the early hours evaluated in sedation window. In total, we recorded two deaths (12.5%). A functional outcome between mRS 0–3, defined as favourable, was observed in 9 (64.2%) patients 9 months after discharge. A functional outcome between mRS 4–6, defined as poor, was observed in 5 (35.7%) patients 9 months after discharge.Conclusions The obtained clinical results appear, however, substantially overlapping to decompressive craniectomy. Cisternostomy results in a favourable functional outcome after 9 months. This proposed technique permits that the patient no longer should be undergone cranioplasty thus avoiding the possible complications related to this procedure. The results are certainly interesting but higher case numbers are needed to reach definitive conclusions.Data are available upon reasonable request.