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

Stroke and Vascular Neurology

article

Salvatore Massimiliano Cardali¹  Maria Caffo¹  Gerardo Caruso¹  Gianluca Scalia¹  Nicola Gorgoglione¹  Alfredo Conti²  Sergio Lucio Vinci³  Valeria Barresi⁴  Francesca Granata³  Giuseppe Ricciardo¹  Giada Garufi¹  Giovanni Raffa¹  Antonino Germanò¹ 

[1] Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic , University of Messina;Department of Biomedical and Neuromotor Sciences , University of Bologna;Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neuroradiology , University of Messina;Department of Diagnostics and Public Health, Section of Anatomic Pathology , University of Verona

关键词: Stroke;    Magnetic Resonance Imaging;    Intracranial Pressure;   

DOI  :  10.1136/svn-2021-000918

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

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.

【 授权许可】

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