Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Surgery after major stroke also improves survival odds in elderly patients

20.03.2014

In patients over 60, hemicraniectomies save lives but do not prevent severe disability / Clinical study led by Heidelberg University Hospital’s Neurology and Neurosurgery pub-lished in New England Journal of Medicine

Patients who are over the age of 60 and have suffered a major stroke due to blockage of the middle cerebral artery benefit from hemicraniectomy – removal of part of the skull located above the affected brain tissue.


Professor Werner Hacke, Medical Director of Heidelberg University Hospital’s Department of Neurology.

Photo: Heidelberg University Hospital


Professor Andreas Unterberg, Medical Director of Heidelberg University Hospital’s Department of Neurosurgery.

Photo: Heidelberg University Hospital

The procedure relieves increased pressure on the brain in the first 48 hours after the stroke. These patients’ chances of survival increase two-fold if they undergo surgery. However, patients who have been operated on often survive with severe disabilities, while patients who do not undergo the surgery generally die quickly.

These findings were obtained in a study conducted by 13 German stroke centers led by Heidelberg University Hospital’s Departments of Neurology and Neurosurgery and have been published in the current issue of the renowned 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 showed that in patients below the age of 60, the results of the procedure are more favorable (see Lancet Neurology, 2007 under Literature). “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 severe stroke

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%.

Strict indications and additional studies warranted

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 already 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 reported. “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.

Literature:
Hemicraniectomy in Older Patients with Extensive Middle-Cerebral-Artery Stroke; Jüttler, E., Unterberg, A., Woitzik, J. , Bösel, J., Amiri, H., Sakowitz, O., Gondan, M., Schiller, P., Lamprecht, R., Luntz, S., Schneider, H., Pinzer, Th., Hobohm, C., Meixensberger, J., and Hacke W., for the DESTINY II Investigators , N Engl J Med. 2014 March 20;370(12):1-9. DOI: 10.1056/NEJMoa1311367

Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W; DECIMAL, DESTINY, and HAMLET investigators: Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007 Mar;6(3):215-22. doi:10.1016/S1474-4422(07)70036-4

Internet:
Heidelberg University Hospital Department of Neurology:
http://www.klinikum.uni-heidelberg.de/Neurologische-Klinik.106839.0.html
Heidelberg University Hospital Department of Neurosurgery:
http://www.klinikum.uni-heidelberg.de/Neurochirurgische-Klinik.120354.0.html

Contact:
Professor Werner Hacke
Managing Director
Heidelberg University Hospital Department of Neurology
Tel: +49 (0) 6221 56-8210

Professor Andreas Unterberg
Managing Director

Heidelberg University Hospital Department of Neurosurgery
Tel: +49 (0) 6221 56-6301

Heidelberg University Hospital and Medical Faculty:
Internationally recognized patient care, research, and teaching

Heidelberg University Hospital is one of the largest and most prestigious medical centers in Germany. The Medical Faculty of Heidelberg University belongs to the internationally most renowned biomedical research institutions in Europe. Both institutions have the common goal of developing new therapies and implementing them rapidly for patients. With about 11,000 employees, training and qualification is an important issue. Every year, around 118,000 patients are treated on an inpatient basis and around 1.000.000 cases on an outpatient basis in more than 50 clinics and departments with 2,200 beds. Currently, about 3,500 future physicians are studying in Heidelberg; the reform Heidelberg Curriculum Medicinale (HeiCuMed) is one of the top medical training programs in Germany.

Requests by journalists:
Dr. Annette Tuffs
Director, Corporate Communication/Public Relations
University Hospital and
Medical Faculty of Heidelberg
Im Neuenheimer Feld 672
69120 Heidelberg
Germany
phone: +49 (0) 6221 56-4536
fax: +49 (0) 6221 56-4544
e-mail: annette.tuffs@med.uni-heidelberg.de

Selected english press releases online:
http://www.klinikum.uni-heidelberg.de/presse

Dr. Annette Tuffs | idw - Informationsdienst Wissenschaft

Further reports about: Neurology Neurosurgery cerebral intensive pressure prognosis stroke surgery

More articles from Health and Medicine:

nachricht Real-time imaging of lung lesions during surgery helps localize tumors and improve precision
30.07.2015 | American Association for Thoracic Surgery

nachricht Experimental MERS vaccine shows promise in animal studies
29.07.2015 | NIH/National Institute of Allergy and Infectious Diseases

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Glaciers melt faster than ever

Glacier decline in the first decade of the 21st century has reached a historical record, since the onset of direct observations. Glacier melt is a global phenomenon and will continue even without further climate change. This is shown in the latest study by the World Glacier Monitoring Service under the lead of the University of Zurich, Switzerland.

The World Glacier Monitoring Service, domiciled at the University of Zurich, has compiled worldwide data on glacier changes for more than 120 years. Together...

Im Focus: Quantum Matter Stuck in Unrest

Using ultracold atoms trapped in light crystals, scientists from the MPQ, LMU, and the Weizmann Institute observe a novel state of matter that never thermalizes.

What happens if one mixes cold and hot water? After some initial dynamics, one is left with lukewarm water—the system has thermalized to a new thermal...

Im Focus: On the crest of the wave: Electronics on a time scale shorter than a cycle of light

Physicists from Regensburg and Marburg, Germany have succeeded in taking a slow-motion movie of speeding electrons in a solid driven by a strong light wave. In the process, they have unraveled a novel quantum phenomenon, which will be reported in the forthcoming edition of Nature.

The advent of ever faster electronics featuring clock rates up to the multiple-gigahertz range has revolutionized our day-to-day life. Researchers and...

Im Focus: Superfast fluorescence sets new speed record

Plasmonic device has speed and efficiency to serve optical computers

Researchers have developed an ultrafast light-emitting device that can flip on and off 90 billion times a second and could form the basis of optical computing.

Im Focus: Unlocking the rice immune system

Joint BioEnergy Institute study identifies bacterial protein that is key to protecting rice against bacterial blight

A bacterial signal that when recognized by rice plants enables the plants to resist a devastating blight disease has been identified by a multi-national team...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Euro Bio-inspired - International Conference and Exhibition on Bio-inspired Materials

23.07.2015 | Event News

Clash of Realities – International Conference on the Art, Technology and Theory of Digital Games

10.07.2015 | Event News

World Conference on Regenerative Medicine in Leipzig: Last chance to submit abstracts until 2 July

25.06.2015 | Event News

 
Latest News

Study offers new insights on hurricane intensity, pollution transport

03.08.2015 | Earth Sciences

Crystal clear images uncover secrets of hormone receptors

03.08.2015 | Life Sciences

Glaciers melt faster than ever

03.08.2015 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>