Objective: Several reports described a beneficial effect of both decompressive hemicraniectomy and therapeutic hypothermia in the management of intractable cerebral edema caused by ischemic stroke. We compared the clinical course and functional outcome in patient with ischemic stroke who were treated with a combination therapy with decompressive hemicraniectomy and therapeutic hypothermia of 33.5°C (DT) or received decompressive hemicraniectomy alone (DA), respectively.
Methods: We retrospectively reviewed of subjects who were received decompressive hemicraniectomy secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both from 2004 to 2015. 26 patients were treated by DA and 10 patients received a combination of DT. functional outcome was assessed at 30 days and at 90 days.
Results: Age, initial National institutes of Health Stroke Scale score, volume of cerebral infarction in diffusion weight imaging, risk factors for ischemic stroke were not significantly different between both groups. Median time from symptom onset to decompressive hemicraniectomy were not significantly different. Therapeutic hypothermia was induced after surgery and maintained. (median duration : 159.9 hours). The difference between presurgical and postsurgical midline shift of septum pellucidum and pineal gland in cranial computed tomography scans did not differ significantly between both groups. Duration of need for intensive care or for mechanical ventilation were not significantly different between both groups. There is a difference in mortality rate at 30 days (0% in DT group vs. 26.9% in DA group). The median modified Rankin Scale (mRS) score at 30 and 90 days were 5 and 4, respectively in both groups. Good functional outcome (mRS scores of 0-3) at 90days was observed in 10% of DT group and 5.9% in DA group.
Conclusion: The present study suggests that a combination therapy of decompressive hemicraniectomy and therapeutic hypothermia improves mortality rate and functional outcome as compared with decompressive hemicraniectomy alone. The main limitation of this study include its retrospective single-center nature, which may limit generalizablility of the study