RESUMEN
OBJECTIVE: The aim of this study was to evaluate the safety and outcomes of decompressive craniectomy (DC) after intravenous tissue plasminogen activator (IV tPA) administration for malignant cerebral infarction. METHODS: We retrospectively reviewed patients who underwent DC for malignant cerebral infarction. We compared fourteen patients who underwent DC after IV tPA administration with another nine patients who underwent DC without prior IV tPA administration. RESULTS: Twenty-three patients underwent DC for malignant hemispheric cerebral infarction in our hospital for five years. Fibrinolysis was performed prior to the DC in fourteen patients (60,9%). The patients characteristics did not differ between the DC patients with and without prior IV tPA administration. The complications that developed after DC were similar in both groups: in patients who underwent DC after IV tPA administration, 9 (64.3%) developed haemorrhagic transformation and 6 (42.9%) developed hydrocephalus. The functional outcome, as the 6-month GOS, was similar in both groups (p = 0.762). ICU mortality (p = 0.329) and hospital mortality after ICU (p= 0.634) were also similar between the two groups. CONCLUSION: Although the main limitation is that the number of patients in our serie was small, which reduced the statistical power, our study suggest that DC after failure of IV tPA administration for malignant cerebral infarction is safe and did not cause an excess of complications arising from the use of fibrinolytic.
Asunto(s)
Craniectomía Descompresiva , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Accidente Cerebrovascular/cirugía , Activador de Tejido Plasminógeno/uso terapéutico , Adulto , Anciano , Craniectomía Descompresiva/efectos adversos , Craniectomía Descompresiva/métodos , Femenino , Humanos , Infarto de la Arteria Cerebral Media/cirugía , Infusiones Intravenosas/métodos , Masculino , Persona de Mediana Edad , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del TratamientoAsunto(s)
Embolia Paradójica/diagnóstico , Extremidad Inferior/irrigación sanguínea , Embolia Pulmonar/diagnóstico , Tromboembolia/diagnóstico , Enfermedad Aguda , Anciano , Anticoagulantes/uso terapéutico , Embolia Paradójica/terapia , Servicio de Urgencia en Hospital , Arteria Femoral/diagnóstico por imagen , Foramen Oval Permeable/diagnóstico , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Arteria Poplítea/diagnóstico por imagen , Embolia Pulmonar/etiología , Embolia Pulmonar/terapia , Respiración Artificial , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Tromboembolia/terapia , Terapia Trombolítica , Tomografía Computarizada por Rayos X , Filtros de Vena CavaAsunto(s)
Mordeduras y Picaduras/complicaciones , Perros , Infecciones por Pasteurella/microbiología , Pasteurella multocida , Infección de Heridas/microbiología , Adulto , Animales , Antibacterianos/uso terapéutico , Mordeduras y Picaduras/microbiología , Traumatismos de la Mano/microbiología , Traumatismos de la Mano/terapia , Humanos , Masculino , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/terapia , Infecciones por Pasteurella/tratamiento farmacológico , Sepsis/microbiología , Sepsis/terapia , Infección de Heridas/tratamiento farmacológicoRESUMEN
Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique.