TORONTO (April 23, 2001) -- A recent study has confirmed the value of a surgical
procedure in dramatically reducing death and disability associated with a major stroke. Bob S. Carter, MD, a neurosurgeon from Boston, and his colleagues, William T. Curry Jr., MD and Christopher S. Ogilvy, MD, from Massachusetts General Hospital will discuss their findings at the 69th Annual Scientific Meeting of the American Association of Neurological Surgeons on Wednesday, April 25.
Temporarily removing part of the skull, a surgical procedure called a hemicraniectomy, can relieve the pressure inside the skull caused by brain swelling after a stroke. Without such relief, brain tissue is damaged as the pressure builds and twists the brain stem.
The Massachusetts General Hospital (MGH) team found that 25 of 29 patients who underwent a hemicraniectomy after a major stroke survived the hospitalization. The cause of three of the deaths was non-neurological. The normal death rate from a massive stroke is nearly 80 percent.
Hemicraniectomy has been used as far back as late 1800s. It fell out of favor until recent years because patients emerged from the surgery with severe disabilities.
However, the MGH study showed that a significant quality of life is possible. The majority of patients regained consciousness after the procedure. Most could talk and some younger patients were able to walk (some with assistance).
The improved quality of life may be because hemicraniectomy is being performed more quickly following a stroke. "We used to think of hemicraniectomy as a last resort when a patient lapsed into deep coma. Now we operate earlier in hopes of avoiding further trauma to the brain," said Dr. Carter.
The Massachusetts General team, the University of Chicago, and a medical team in Germany are among the research groups working to prove the effectiveness of the procedure. "From anecdotal sources, I'd say about half of the major medical centers in the United States have done at least one hemicraniectomy for stroke," said Dr. Carter. "However, many patients with stroke are treated at community hospitals. I hope our study increases awareness of this option in the community."
A hemicraniectomy involves removing a side portion of the skull to allow room for the brain to swell. The scalp and the dura, a hard inner membrane beneath the scalp, are then sewn together. During the three months or so it takes for the brain swelling to end, the part of the skull that was removed is placed in the abdomen for safekeeping.
"The operation is not technically demanding. It is within the capabilities of any neurosurgeon," Dr. Carter said.
Patients typically wear a helmet during the healing. Most chose to undergo a cranioplasty, in which the bone is re-inserted to fill the hole in the skull.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons is a scientific and educational association with nearly 5,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are Board-certified by the American Board of Neurological Surgery. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves.
