• World Neurosurg · Dec 2021

    Decompressive craniectomy for hemispheric infarction in a low-income population.

    • Everardo Garcia-Estrada, Jesús Alberto Morales-Gómez, Mariana Romero-González, Ricardo Gerardo Martínez-Ortíz, Marco Antonio García-Hernández, César Alessandro Ramos-Delgado, Paúl André López-Hernández, Isaac Jair Palacios-Ortiz, and Angel Raymundo Martínez-Ponce de León.
    • Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
    • World Neurosurg. 2021 Dec 1; 156: e152-e159.

    BackgroundStroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC).MethodsA retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome.ResultsForty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again.ConclusionsAge group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient.Copyright © 2021 Elsevier Inc. All rights reserved.

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