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Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children

Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children
Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children

Aim: Mortality from malignant middle cerebral artery infarction (MMCAI) approaches 80% in adult series. Although decompressive craniectomy decreases mortality and leads to an acceptable outcome in selected adult patients, there are few data on MMCAI in children with stroke. This study evaluated the frequency of MMCAI and the use of decompressive craniectomy in children. Method: We retrospectively reviewed cases of MMCAI from five pediatric tertiary care centers. Results: Ten children (two females, eight males; median age 9y 10mo, range 22mo-14y) had MMCAI, with a median Glasgow Coma Scale score of 6 (range 3-9). MMCAI represented fewer than 2% of cases of pediatric arterial ischemic stroke. Three patients who did not undergo decompression, all of whom had monitoring of intracranial pressure, developed intractable intracranial hypertension, and fulfilled criteria for brain death. In contrast, seven patients underwent decompressive craniectomy and survived, with rapid improvement in their level of consciousness postoperatively. All seven survivors now walk independently with mild to moderate residual hemiparesis and speak fluently, even though four had left-sided infarcts. Interpretation: Decompressive craniectomy can lead to a moderately good outcome for children with MMCAI and should be considered, even with symptomatic stroke and deep coma. Monitoring of intracranial pressure may delay life-saving treatment.

0012-1622
29-33
Smith, Sabrina E.
5a935695-cb3e-4bd1-ae2c-34ff6cced25c
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Deveber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Millman, Guy
47618a96-2c47-4904-bbb4-32073e8a3cd1
Dirks, Peter B.
05a63b83-83a3-41a6-ba5f-783451f72c43
Wirrell, Elaine
67b33402-9858-41f6-9bbc-75a1f1e87a3b
Telfeian, Albert E.
4ea28a53-ceb6-4d39-8926-9bd7f8b3a664
Sykes, Kim
4ac66268-7471-42e2-a640-2c383372cc72
Barlow, Karen
87dc35a4-d5d9-4cb9-aabb-fbb9234fddd1
Ichord, Rebecca
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8
Smith, Sabrina E.
5a935695-cb3e-4bd1-ae2c-34ff6cced25c
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Deveber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Millman, Guy
47618a96-2c47-4904-bbb4-32073e8a3cd1
Dirks, Peter B.
05a63b83-83a3-41a6-ba5f-783451f72c43
Wirrell, Elaine
67b33402-9858-41f6-9bbc-75a1f1e87a3b
Telfeian, Albert E.
4ea28a53-ceb6-4d39-8926-9bd7f8b3a664
Sykes, Kim
4ac66268-7471-42e2-a640-2c383372cc72
Barlow, Karen
87dc35a4-d5d9-4cb9-aabb-fbb9234fddd1
Ichord, Rebecca
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8

Smith, Sabrina E., Kirkham, Fenella J., Deveber, Gabrielle, Millman, Guy, Dirks, Peter B., Wirrell, Elaine, Telfeian, Albert E., Sykes, Kim, Barlow, Karen and Ichord, Rebecca (2011) Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children. Developmental Medicine and Child Neurology, 53 (1), 29-33. (doi:10.1111/j.1469-8749.2010.03775.x).

Record type: Article

Abstract

Aim: Mortality from malignant middle cerebral artery infarction (MMCAI) approaches 80% in adult series. Although decompressive craniectomy decreases mortality and leads to an acceptable outcome in selected adult patients, there are few data on MMCAI in children with stroke. This study evaluated the frequency of MMCAI and the use of decompressive craniectomy in children. Method: We retrospectively reviewed cases of MMCAI from five pediatric tertiary care centers. Results: Ten children (two females, eight males; median age 9y 10mo, range 22mo-14y) had MMCAI, with a median Glasgow Coma Scale score of 6 (range 3-9). MMCAI represented fewer than 2% of cases of pediatric arterial ischemic stroke. Three patients who did not undergo decompression, all of whom had monitoring of intracranial pressure, developed intractable intracranial hypertension, and fulfilled criteria for brain death. In contrast, seven patients underwent decompressive craniectomy and survived, with rapid improvement in their level of consciousness postoperatively. All seven survivors now walk independently with mild to moderate residual hemiparesis and speak fluently, even though four had left-sided infarcts. Interpretation: Decompressive craniectomy can lead to a moderately good outcome for children with MMCAI and should be considered, even with symptomatic stroke and deep coma. Monitoring of intracranial pressure may delay life-saving treatment.

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More information

Accepted/In Press date: 5 July 2010
e-pub ahead of print date: 30 August 2010
Published date: January 2011

Identifiers

Local EPrints ID: 429223
URI: http://eprints.soton.ac.uk/id/eprint/429223
ISSN: 0012-1622
PURE UUID: 708f0993-a682-4898-b9f9-ba1f5362fbc8
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 22 Mar 2019 17:30
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Sabrina E. Smith
Author: Gabrielle Deveber
Author: Guy Millman
Author: Peter B. Dirks
Author: Elaine Wirrell
Author: Albert E. Telfeian
Author: Kim Sykes
Author: Karen Barlow
Author: Rebecca Ichord

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