Navigation Links
Surgery after major stroke also improves survival odds in elderly patients

Patients who are over the age of 60 and have suffered a major stroke due to blockage of the middle cerebral artery benefit from hemicraniectomy removal of part of the skull located above the affected brain tissue. The procedure relieves increased pressure on the brain in the first 48 hours after the stroke. These patients' chances of survival increase two-fold if they undergo surgery. However, patients who have been operated on often survive with severe disabilities, while patients who do not undergo the surgery generally die quickly. These findings were obtained in a study conducted by 13 German stroke centers led by Heidelberg University Hospital's Departments of Neurology and Neurosurgery and have been published in the current issue of the renowned New England Journal of Medicine.

"For the first time, it has now been proven that for a cohort of elderly patients too, hemicraniectomy can save lives," explained Professor Werner Hacke, Medical Director of Heidelberg University Hospital's Department of Neurology. A study published 5 years ago showed that in patients below the age of 60, the results of the procedure are more favorable (see Lancet Neurology, 2007 under Literature). "In younger patients, the surgery tripled the chances of survival. In addition, they rarely sustained severe disabilities," said Professor Andreas Unterberg, Medical Director at Heidelberg University Hospital's Department of Neurosurgery. "We were not surprised by the lower treatment effect in the current study, since we know that the older a stroke patient, the poorer his or her prognosis."

Elderly patients: Overall poorer prognosis after severe stroke

The prognosis in patients with a blockage of the middle cerebral artery is very poor. In nearly 80% of the patients, without surgery, it causes death in a matter of days, even if they receive the maximum possible conservative intensive care. The necrotic brain tissue and its surroundings expand due to brain swelling (edema) and intracranial pressure severely increases, destroying vitally important brain tissue. The decompression surgery provides space for the swollen brain tissue in the critical phase. The exposed brain is covered with a protective membrane. Once brain swelling has decreased, the removed bone flap is replaced. The procedure has low risks, can be performed quickly and has few complications. Since its efficacy was proven in younger patients (below 60), it has become the standard treatment at many stroke centers. The surgery reduced mortality in younger patients from a rate of over 70% to around 20%.

Strict indications and additional studies warranted

The results of the current study are highly significant for the treatment of elderly stroke patients. The analysis includes 112 patients between the ages of 61 and 82 who had experienced a severe stroke and were treated with intensive care only or who underwent a hemicraniectomy within 48 hours of the stroke. The study was already stopped after the inclusion of 83 patients due to the clear superiority of the surgical procedure. The use of hemicraniectomies reduced the mortality rate from 70% to 33%. However, the proportion of very severely disabled patients in the group undergoing the procedure was nearly 30%.

"Many patients do not accept the notion of survival with severe disability, especially in very old age," Professor Unterberg reported. "For this reason, in older patients in particular, the pros and cons of the procedure must be discussed with the patients and their families," Professor Hacke added. Neurosurgeons and neurologists therefore need to discuss this type of treatment with patients and their families. Further studies may succeed in finding out which older patients especially will benefit from a hemicraniectomy.


Contact: Professor Werner Hacke
Heidelberg University Hospital

Related medicine news :

1. Esophageal Cancer Surgery Can Leave Lingering Health Problems, Study Says
2. Optimal care of bariatric surgery patients vital for long-term health and well-being
3. Codeine After Surgery Could Endanger Certain Kids: Study
4. Surgery Rates Rising for Non-Melanoma Skin Cancer: Study
5. Study examines medicare use for Mohs micrographic surgery and surgical excision for skin cancer
6. Weight-Loss Surgery Beat Drugs for Cutting Diabetes in Very Obese
7. Brain Surgery Might Ease Tough-to-Treat OCD
8. Men More Prone to Complications After Brain, Spine Surgery
9. Lower Risk for Bowel Obstruction With Less Invasive Surgery: Study
10. Brain surgery for epilepsy underutilized
11. New Techniques May Improve Infant Heart Surgery
Post Your Comments:
Related Image:
Surgery after major stroke also improves survival odds in elderly patients
(Date:11/27/2015)... (PRWEB) , ... November 27, 2015 , ... ... the largest, most successful and prominent nonprofit healthcare organizations in the country. They ... involvement with various organizations, and helped advance the healthcare industry as a whole ...
(Date:11/26/2015)... ... November 26, 2015 , ... Patients at ... Michigan, have come together on Thanksgiving Day to share the things that they ... on the Serenity Point YouTube channel, patients displayed what they wrote on index ...
(Date:11/26/2015)... ... November 26, 2015 , ... The Catalent Applied Drug ... need to integrate dose form selection in early phase drug development. The first ... supporting and bringing together the UK’s emerging life sciences companies, corporate partners, and ...
(Date:11/26/2015)... CA (PRWEB) , ... November 26, 2015 , ... ... a new set of retro-fused, self-animating trailer titles with ProTrailer: Vintage. This newly ... options. These classically-influenced trailer titles work with any font, giving users limitless opportunities ...
(Date:11/25/2015)... ... November 25, 2015 , ... As part of ... Empowerment ™ attracts volunteers together who want to combine talents and resources to ... stakeholders in the process. The non-profit launched its first major fundraiser on November ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... -- The total global healthcare industry is expected to grow at ... America has the highest projected growth at 12.7%, ... ), is second with growth projected at 11.5%. ... expenditure. In 2013-2014, total government funded healthcare was nearly 68%. ... 41.2% in 2013-2014. In real terms, out of pocket expenditure ...
(Date:11/25/2015)...  The American Academy of Pediatrics (AAP), American ... March of Dimes cheered today,s signature into law ... of 2015 (S.799), which takes much-needed strides ... to drugs, such as opioids, and to improve ... organizations have worked together leading advocacy efforts for ...
(Date:11/25/2015)... Nov. 25, 2015 AAIPharma Services Corp./Cambridge ... of at least $15.8  Million to expand its ... NC . The expansion will provide additional ... the growing demands of the pharmaceutical and biotechnology ... expansion will provide up to 40,000 square feet ...
Breaking Medicine Technology: