Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale.

BACKGROUND: Patient's age is considered to be one of the most relevant factors in selecting surgical candidates for decompressive hemicraniectomy after malignant hemispheric infarction. However, questions about surgical indication in older patients, patients with consciousness disorder or patients with large infarctions remain unanswered. OBJECTIVE: Our aim was to design a multifactorial scoring scale based on a combination of patient-specific factors in order to optimize the assessment of prognosis in patients after hemicraniectomy malignant strokes. METHODS: In this prospective observational study with a one-year follow-up, we assessed clinical and imaging data of patients who underwent decompressive hemicraniectomy due to malignant brain infarction. Barthel index was used as a single outcome measure to distinguish favorable vs. unfavorable outcomes. Associations between multiple variables and clinical outcome were assessed. Subsequently, a design of a predictive scoring system was proposed. RESULTS: Age of the patient, preoperative level of consciousness, midline shift, and volume of infarction showed a significant association with postoperative Barthel index. According to the identified factors, a multifactorial prognostic scoring system was introduced, aimed to distinguish between favorable and unfavorable outcomes. Using ROC analysis, it has achieved an AUC of 0.74 (95%CI 0.58‒0.89, p=0.01)CONCLUSIONS: Prediction of postoperative outcome should be based on multiple variables. Our scale, based on the clinical and imaging data, can be used during decision-making to estimate potential benefit of decompressive craniectomy in patients after malignant brain infarction (Tab. 5, Fig. 1, Ref. 32). Text in PDF www.elis.sk Keywords: decompressive hemicraniectomy, malignant hemispheric infarction, indication, outcome, prediction.

Transient myopia as rare condition after neurosurgery.

Refractive changes may be caused by systemic diseases such as diabetes mellitus, lupus erythematosus, or hypothyroidism. However, refractive changes following the removal of a brain tumour have not been reported. In our case report, we describe a young woman without any systemic disease. She came to the emergency department in our hospital, where she reported a headache on admission and no other difficulties. Vital computer tomography was performed at the emergency outpatient clinic. The frontoparietal round hypodense lesion with an indicated dense margin - suspicious abscess, was detected. The patient was admitted to the Neurological Department of Slovak Medical University to have her condition diagnosed. After magnetic resonance, she was admitted to the Neurosurgery department, she underwent a neurosurgical procedure, where the diffuse anaplastic glioma grade II was histopathologically confirmed. Afterward, she reported worsening of vision. We diagnosed transient myopia, which is a rare condition. One month after the procedure the patient's eyes were again emmetropic without any harm on eyes.