Senior Stroke Patients Double Survival with Surgery
to Relieve Brain Pressure
Proven successful with patients under 60, it has now
been proven that hemicraniectomy surgery can save elderly lives, too
March 20, 2014 – Seniors over the age of 60 double
their chance of surviving a major stroke due to blockage of the middle
cerebral artery if they undergo surgery in the first 48 hours to remove
part of the skull above the affected brain tissue to relieve pressure on
the brain. But, the news is not all good – they often survive with
severe disabilities. On the other hand, those without this surgery
generally die quickly, according to a new study.
These findings on this surgery (hemicraniectomy)
came from a study conducted by 13 German stroke centers led by
Heidelberg University Hospital’s Departments of Neurology and
Neurosurgery. The report is published in the current New England
Journal of Medicine.
“For the first time, it has now been proven that
for a cohort of elderly patients too, hemicraniectomy can save lives,”
explained Professor Werner Hacke, Medical Director of Heidelberg
University Hospital’s Department of Neurology.
A study published 5 years ago in Lancet
Neurology showed that in patients below the age of 60, the results
of the procedure are more favorable.
“In younger patients, the surgery tripled the
chances of survival. In addition, they rarely sustained severe
disabilities,” said Professor Andreas Unterberg, Medical Director at
Heidelberg University Hospital’s Department of Neurosurgery.
“We were not surprised by the lower treatment
effect in the current study, since we know that the older a stroke
patient, the poorer his or her prognosis.”
Elderly patients: Overall poorer prognosis after
The prognosis in patients with a blockage of the
middle cerebral artery is very poor. In nearly 80% of the patients,
without surgery, it causes death in a matter of days, even if they
receive the maximum possible conservative intensive care.
The necrotic brain tissue and its surroundings
expand due to brain swelling (edema) and intracranial pressure severely
increases, destroying vitally important brain tissue.
The decompression surgery provides space for the
swollen brain tissue in the critical phase. The exposed brain is covered
with a protective membrane. Once brain swelling has decreased, the
removed bone flap is replaced.
The procedure has low risks, can be performed
quickly and has few complications. Since its efficacy was proven in
younger patients (below 60), it has become the standard treatment at
many stroke centers. The surgery reduced mortality in younger patients
from a rate of over 70% to around 20%.
A stroke is a medical
emergency. Strokes happen when blood flow to your brain stops.
Within minutes, brain cells begin to die. There are two kinds of
stroke. The more common kind, called ischemic stroke, is caused
blood clot that blocks or plugs a blood vessel in the brain.
The other kind, called hemorrhagic stroke, is caused by a blood
vessel that breaks and bleeds into the brain. "Mini-strokes" or
transient ischemic attacks (TIAs), occur when the blood
supply to the brain is briefly interrupted.
Symptoms of stroke are
• Sudden numbness or
weakness of the face, arm or leg (especially on one side of the
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or
• Sudden severe headache with no known cause
If you have any of these
symptoms, you must get to a hospital quickly to begin treatment.
Acute stroke therapies try to stop a stroke while it is
happening by quickly dissolving the blood clot or by stopping
the bleeding. Post-stroke rehabilitation
helps individuals overcome disabilities that result from stroke
damage. Drug therapy with blood thinners
is the most common treatment for stroke.
Strict indications and additional studies
The results of the current study are highly
significant for the treatment of elderly stroke patients. The analysis
includes 112 patients between the ages of 61 and 82 who had experienced
a severe stroke and were treated with intensive care only or who
underwent a hemicraniectomy within 48 hours of the stroke. The study was
stopped after the inclusion of 83 patients due to the clear superiority
of the surgical procedure.
The use of hemicraniectomies reduced the mortality
rate from 70% to 33%. However, the proportion of very severely disabled
patients in the group undergoing the procedure was nearly 30%.
“Many patients do not accept the notion of survival
with severe disability, especially in very old age,” Professor Unterberg
“For this reason, in older patients in particular,
the pros and cons of the procedure must be discussed with the patients
and their families,” Professor Hacke added.
“Neurosurgeons and neurologists therefore need to
discuss this type of treatment with patients and their families. Further
studies may succeed in finding out which older patients especially will
benefit from a hemicraniectomy.”
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