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Surgery after major stroke also improves survival odds in elderly patients
Date:3/20/2014

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.


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Contact: Professor Werner Hacke
werner.hacke@med.uni-heidelberg.de
49-062-215-68210
Heidelberg University Hospital
Source:Eurekalert  

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