Surgical Decompression Reduces Cerebral Edema in Stroke

Surgical decompression following acute ischemic stroke resulted in significant reduction of death or severe disability one year after recovery, according to a new study.

Researchers at the Saint Louis University School of Medicine (MO, USA) searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966-2010), EMBASE (1980-2010) and the Science Citation Index for studies that examined the effects of decompressive surgery in patients with massive acute ischemic stroke complicated with cerebral edema, as compared to medical treatment alone. Main outcome measures were death at the end of follow-up, death or disability defined as over 3 on the modified Rankin Scale (mRS) at the end of follow-up, death or severe disability defined as mRS over 4 at 12 months, and disability defined as mRS 4 or 5 at 12 months.

The results showed that surgical decompression reduced the risk of death at the end of follow-up and the risk of death or disability (mRS > 4) at 12 months. Death or disability defined as mRS over 3 at the end of follow-up was no different between the treatment arms. Among the 134 adults included in three studies, two studies used a time window from stroke onset of 30 hours to decompression, and 96 hours in the third study. All patients were 60 years of age or younger, and all trials were stopped early. The study was published in the first quarter 2012 issue of the Cochrane Database of Systemic Revues.

“While decompression improves survival and the combined outcome of death and severe disability, the effects on functional outcome are not proven and the patient may survive with significant disability,” concluded lead author Salvador Cruz-Flores, MD, and colleagues of the department of neurology and psychiatry. “The implications for quality of life should be considered when considering this intervention.”

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