RESUMO
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.
Assuntos
Craniectomia Descompressiva , Infarto da Artéria Cerebral Média/tratamento farmacológico , Acidente Vascular Cerebral/cirurgia , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/métodos , Feminino , Humanos , Infarto da Artéria Cerebral Média/cirurgia , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do TratamentoAssuntos
Embolia Paradoxal/diagnóstico , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/diagnóstico , Tromboembolia/diagnóstico , Doença Aguda , Idoso , Anticoagulantes/uso terapêutico , Embolia Paradoxal/terapia , Serviço Hospitalar de Emergência , Artéria Femoral/diagnóstico por imagem , Forame Oval Patente/diagnóstico , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Artéria Poplítea/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tromboembolia/terapia , Terapia Trombolítica , Tomografia Computadorizada por Raios X , Filtros de Veia CavaRESUMO
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.
