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Decompressive craniectomy for severe middle cerebral artery infarction: a meta-analysis of randomised controlled trials
Poster Abstracts
Decompressive craniectomy for severe middle cerebral artery infarction: a meta-analysis of randomised controlled trials Yuping Li*, Mengzhuo Hou*, Guangyu Lu, Natalia Ciccone, Lun Dong, Zhengcun Yan, Chen Cheng, Xingdong Wang, Hengzhu Zhang
Abstract Published Online October 30, 2016 *Contributed equally Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China (Y Li MD, Prof L Dong, Z Yan MSc, X Wang MSc, Prof H Zhang); Department of Neurosurgery, Neurosurgical Research, Ludwig-Maximilians University of Munich, Munich, Germany (Y Li, M Hou MD, N Ciccone MSc); Institute of Public Health, Medical School of RuprechtKarls-University Heidelberg, Heidelberg, Germany (G Lu PhD); Medicine School of Nankai University, Tianjing, China (C Cheng PhD); and Department of Neurology, General Hospital of the Chinese People’s Liberation Army, Beijing, China (C Cheng) Correspondence to: Prof Hengzhu Zhang, Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu 225001, China [email protected]
Background Severe middle cerebral artery infarction is defined as an acute infarction in the entire middle cerebral artery territory. Several case series have indicated that decompressive hemicraniectomy for severe middle cerebral artery infarction is lifesaving. However, data concerning the long-term functional outcome are insufficient. We did a systematic review and meta-analysis to assess the efficacy of decompressive hemicraniectomy for patients with severe middle cerebral artery infarction. Methods According to PRISMA guidelines, we searched databases containing articles published in English (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials CENTRAL) and Chinese (Chinese Biomedical Literature Database, China Science and Technology Journal Database, and China National Knowledge Infrastructure) for randomised controlled trials (RCTs) of decompressive hemicraniectomy published before January, 2016. We extracted data on patient characteristics, methodological quality, and outcome measures. The outcomes assessed included mortality and good functional outcome (GFO). We did a subgroup analysis to determine the effect of age and surgical timing on mortality and functional outcomes. Findings 14 studies were included in this meta-analysis, including 830 patients with severe middle cerebral artery infarction. In the total population, mortality was lower in the decompressive hemicraniectomy group than in the conventional treatment group at 6 months after onset (odds ratio [OR] 0·19, 95% CI 0·11–0·33; p<0·0001), and at 12 months (OR 0·18, 0·11–0·28; p<0·0001). The pooled OR of GFO was 3·15 (95% CI 1·49–6·69; p=0·003) at 6 months, and 1·95 (1·19–3·19; p=0·008) at 12 months. Survival with moderately severe disability was higher in the decompressive hemicraniectomy group at 6 months (OR 3·90, 95% CI 2·23–6·83; p<0·0001) and 12 months (OR 4·36, 2·55–7·36; p<0·0001). However, with regard to survival with severe disability, no significant differences were observed (p=0·55 at 6 months, p=0·81 at 12 months). In the subgroup analysis, compared with conventional treatment, decompressive hemicraniectomy significantly decreased mortality in patients older than 60 years (p<0·0001) and 60 years or younger (p<0·0001). With regard to survival with moderately severe or severe disability, significant differences were observed between treatment groups both in patients older than 60 years (p=0·0002) and 60 years or younger (p=0·0002). No significant differences between treatment groups were found in the subgroup analysis of surgical timing. Interpretation Compared with conventional treatment, decompressive hemicraniectomy could significantly reduce mortality and improve prognosis both in patients older than 60 years and those aged 60 years or younger with severe middle cerebral artery infarction. However, compared with conventional treatment, more patients who receive decompressive hemicraniectomy might survive with moderately severe or severe disability. Funding None. Contributors YL, MH, GL, and HZ were responsible for the study concept and design. MH and YL were responsible for the development and implementation of the literature search strategy. GL, MH, YL, HZ, and XW acquired the data, and did the review of the literature search results and data abstraction. GL, MH, YL, XW, and ZY analysed and interpreted the data. GL, MH, YL, CC, and NC drafted the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content. XW, ZY, LD, GL, and MH did the statistical analysis. MH, GL, HZ, NC provided administrative, technical, and material support. HZ and YL supervised the study. Declaration of interests We declare no competing interests.
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Decompressive craniectomy for severe middle cerebral artery infarction: a meta-analysis of randomised controlled trials Yuping Li*, Mengzhuo Hou*, Guangyu Lu, Natalia Ciccone, Lun Dong, Zhengcun Yan, Chen Cheng, Xingdong Wang, Hengzhu Zhang
Abstract Published Online October 30, 2016 *Contributed equally Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China (Y Li MD, Prof L Dong, Z Yan MSc, X Wang MSc, Prof H Zhang); Department of Neurosurgery, Neurosurgical Research, Ludwig-Maximilians University of Munich, Munich, Germany (Y Li, M Hou MD, N Ciccone MSc); Institute of Public Health, Medical School of RuprechtKarls-University Heidelberg, Heidelberg, Germany (G Lu PhD); Medicine School of Nankai University, Tianjing, China (C Cheng PhD); and Department of Neurology, General Hospital of the Chinese People’s Liberation Army, Beijing, China (C Cheng) Correspondence to: Prof Hengzhu Zhang, Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu 225001, China [email protected]
Background Severe middle cerebral artery infarction is defined as an acute infarction in the entire middle cerebral artery territory. Several case series have indicated that decompressive hemicraniectomy for severe middle cerebral artery infarction is lifesaving. However, data concerning the long-term functional outcome are insufficient. We did a systematic review and meta-analysis to assess the efficacy of decompressive hemicraniectomy for patients with severe middle cerebral artery infarction. Methods According to PRISMA guidelines, we searched databases containing articles published in English (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials CENTRAL) and Chinese (Chinese Biomedical Literature Database, China Science and Technology Journal Database, and China National Knowledge Infrastructure) for randomised controlled trials (RCTs) of decompressive hemicraniectomy published before January, 2016. We extracted data on patient characteristics, methodological quality, and outcome measures. The outcomes assessed included mortality and good functional outcome (GFO). We did a subgroup analysis to determine the effect of age and surgical timing on mortality and functional outcomes. Findings 14 studies were included in this meta-analysis, including 830 patients with severe middle cerebral artery infarction. In the total population, mortality was lower in the decompressive hemicraniectomy group than in the conventional treatment group at 6 months after onset (odds ratio [OR] 0·19, 95% CI 0·11–0·33; p<0·0001), and at 12 months (OR 0·18, 0·11–0·28; p<0·0001). The pooled OR of GFO was 3·15 (95% CI 1·49–6·69; p=0·003) at 6 months, and 1·95 (1·19–3·19; p=0·008) at 12 months. Survival with moderately severe disability was higher in the decompressive hemicraniectomy group at 6 months (OR 3·90, 95% CI 2·23–6·83; p<0·0001) and 12 months (OR 4·36, 2·55–7·36; p<0·0001). However, with regard to survival with severe disability, no significant differences were observed (p=0·55 at 6 months, p=0·81 at 12 months). In the subgroup analysis, compared with conventional treatment, decompressive hemicraniectomy significantly decreased mortality in patients older than 60 years (p<0·0001) and 60 years or younger (p<0·0001). With regard to survival with moderately severe or severe disability, significant differences were observed between treatment groups both in patients older than 60 years (p=0·0002) and 60 years or younger (p=0·0002). No significant differences between treatment groups were found in the subgroup analysis of surgical timing. Interpretation Compared with conventional treatment, decompressive hemicraniectomy could significantly reduce mortality and improve prognosis both in patients older than 60 years and those aged 60 years or younger with severe middle cerebral artery infarction. However, compared with conventional treatment, more patients who receive decompressive hemicraniectomy might survive with moderately severe or severe disability. Funding None. Contributors YL, MH, GL, and HZ were responsible for the study concept and design. MH and YL were responsible for the development and implementation of the literature search strategy. GL, MH, YL, HZ, and XW acquired the data, and did the review of the literature search results and data abstraction. GL, MH, YL, XW, and ZY analysed and interpreted the data. GL, MH, YL, CC, and NC drafted the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content. XW, ZY, LD, GL, and MH did the statistical analysis. MH, GL, HZ, NC provided administrative, technical, and material support. HZ and YL supervised the study. Declaration of interests We declare no competing interests.
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