Evidence-based consensus statement of the standardized surgical decompression for massive cerebral infarction with malignant brain edema_Chinese Journal of Evidence-Based Medicine

Authors：

GUO Rui ¹ , YU Zhiyuan ¹ , WU Simiao ² , REN Yutao ¹ , GUO Fuqiang ³ , DUAN Jinfeng ⁴ , LI Zuoxiao ⁵ , YANG Dongdong ⁶ , WU Bihua ⁷ , WANG Chun ⁸ , LING Tianjin ⁹ , ZHANG Hao ¹⁰ , ZHANG Shihong ² ,  HAO Zilong ² ,  LIU Yi ¹ ,  YOU Chao ¹ ,  LIU Ming ² , on behalf of Severe Ischaemic Stroke Collaboration Group

1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, P.R.China;
4. Department of Neurology, Mianyang Central Hospital, Mianyang 621000, P.R.China;
5. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, P.R.China;
6. Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, P.R.China;
7. Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong 634700, P.R.China;
8. Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, P.R.China;
9. Department of Neurology, the First People’s Hospital of Ziyang, Ziyang 641300, P.R.China;
10. Department of Neurology, Jiangyou People’s Hospital, Mianyang 621000, P.R.China;

Corresponding author：

HAO Zilong, Email: zhilong1983@126.com; LIU Yi, Email: liuyi@wchscu.cn; YOU Chao, Email: youchaosjwk@126.com; LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Ischaemic stroke; Massive; Brain edema; Surgical decompression; Evidence-based; Consensus

DOI：

10.7507/1672-2531.202012011

Video：

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Massive cerebral infarction with malignant brain edema has poor prognosis with very high mortality, despite aggressive medical treatment. Surgical decompression is recommended by Chinese and international clinical guidelines for patients with massive cerebral infarction, however, there is no standardized diagnosis and treatment protocol in clinical practice. Following the principle of evidence-based medicine and based on the diagnosis and treatment norms of the participating hospitals of Severe Ischaemic Stroke Collaboration in recent years, we recommend this consensus statement of the standardized surgical decompression for malignant brain edema in massive cerebral infarction.

Citation： GUO Rui, YU Zhiyuan, WU Simiao, REN Yutao, GUO Fuqiang, DUAN Jinfeng, LI Zuoxiao, YANG Dongdong, WU Bihua, WANG Chun, LING Tianjin, ZHANG Hao, ZHANG Shihong, HAO Zilong, LIU Yi, YOU Chao, LIU Ming, on behalf of Severe Ischaemic Stroke Collaboration Group. Evidence-based consensus statement of the standardized surgical decompression for massive cerebral infarction with malignant brain edema. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 503-513. doi: 10.7507/1672-2531.202012011 Copy

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2. Kimberly WT, Sheth KN. Approach to severe hemispheric stroke. Neurology, 2011, 76(7 Suppl 2): S50-56.
3. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet, 2007, 369(9558): 275-282.
4. Huttner HB, Schwab S. Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol, 2009, 8(10): 949-958.
5. Pillai A, Menon SK, Kumar S, et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection. J Neurosurg, 2007, 106(1): 59-65.
6. 宿英英, 潘速跃, 江文, 等. 大脑半球大面积梗死监护与治疗中国专家共识. 中华医学杂志, 2017, 97(9): 645-652.
7. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2018, 49(3): e46-e110.
8. 彭斌, 吴波. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
9. 刘鸣, 刘峻峰. 中国急性脑梗死后出血转化诊治共识 2019. 中华神经科杂志, 2019, 52(4): 252-265.
10. Hao Z, Chang X, Zhou H, et al. A cohort study of decompressive craniectomy for malignant middle cerebral artery infarction: a real-world experience in clinical practice. Medicine (Baltimore), 2015, 94(25): e1039.
11. 吴思缈, 吴波, 郭富强, 等. 重症脑梗死优化诊治方案及流程建议草案. 华西医学, 2019, 34(10): 1096-1108.
12. 刘鸣, 刘峻峰. 中国脑血管病指南制订方法及应用. 中华神经科杂志, 2015, 48(4): 241-245.
13. 彭斌, 宿英英. 中国重症脑血管病管理共识 2015. 中华神经科杂志, 2016, 49(3): 192-202.
14. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol, 2007, 6(3): 215-222.
15. Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol, 2009, 8(4): 326-333.
16. Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke, 2007, 38(9): 2506-2517.
17. Jüttler E, Schwab S, Schmiedek P, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke, 2007, 38(9): 2518-2525.
18. Raco A, Caroli E, Isidori A, et al. Management of acute cerebellar infarction: one institution's experience. Neurosurgery, 2003, 53(5): 1061-1065.
19. Mostofi K. Neurosurgical management of massive cerebellar infarct outcome in 53 patients. Surg Neurol Int, 2013, 4: 28.
20. Agarwalla PK, Stapleton CJ, Ogilvy CS. Craniectomy in acute ischemic stroke. Neurosurgery, 2014, 74 Suppl 1: S151-162.
21. Jauss M, Krieger D, Hornig C, et al. Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study. J Neurol, 1999, 246(4): 257-264.
22. Pfefferkorn T, Eppinger U, Linn J, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke, 2009, 40(9): 3045-3050.
23. Wijdicks EF, Sheth KN, Carter BS, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(4): 1222-1238.
24. Rahme R, Curry R, Kleindorfer D, et al. How often are patients with ischemic stroke eligible for decompressive hemicraniectomy? Stroke, 2012, 43(2): 550-552.
25. Walcott BP, Kuklina EV, Nahed BV, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS One, 2011, 6(12): e29193.
26. Thomalla G, Hartmann F, Juettler E, et al. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study. Ann Neurol, 2010, 68(4): 435-445.
27. Oppenheim C, Samson Y, Manaï R, et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke, 2000, 31(9): 2175-2181.
28. Hofmeijer J, Algra A, Kappelle LJ, et al. Predictors of life-threatening brain edema in middle cerebral artery infarction. Cerebrovasc Dis, 2008, 25(1-2): 176-184.
29. Wu S, Yuan R, Wang Y, et al. Early prediction of malignant brain edema after ischemic stroke. Stroke, 2018, 49(12): 2918-2927.
30. Ong CJ, Gluckstein J, Laurido-Soto O, et al. Enhanced detection of edema in malignant anterior circulation stroke (EDEMA) score: a risk prediction tool. Stroke, 2017, 48(7): 1969-1972.
31. Cheng Y, Wu S, Wang Y, et al. External validation and modification of the EDEMA score for predicting malignant brain edema after acute ischemic stroke. Neurocrit Care, 2020, 32(1): 104-112.
32. Zhao J, Su YY, Zhang Y, et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit Care, 2012, 17(2): 161-171.
33. Jüttler E, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med, 2014, 370(12): 1091-1100.
34. Torbey MT, Bösel J, Rhoney DH, et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care, 2015, 22(1): 146-164.
35. Maramattom BV, Bahn MM, Wijdicks EF. Which patient fares worse after early deterioration due to swelling from hemispheric stroke? Neurology, 2004, 63(11): 2142-2145.
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Chinese Journal of Evidence-Based Medicine

Evidence-based consensus statement of the standardized surgical decompression for massive cerebral infarction with malignant brain edema

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