Post-Stroke Surgery Increases Survival Rate

By Jane Farrell

Stroke patients over the age of 60 benefit from a post-stroke surgical procedure that temporarily removes part of the skull, researchers have found.

The findings involve people who have suffered a major stroke because of blockage to the middle cerebral artery. The procedure that benefits them is called hemicraniectomy – removal of part of the skull located above the affected brain tissue.  It relieves increased pressure on the brain in the 48 hours after the stroke.

Patients’ chance of survival increases twofold if they have the operation. But those who do survive often do so with severe disabilities; without the surgery, though, patients often die quickly.

The study was conducted by 13 German stroke centers led by Heidelberg University Hospital’s Departments of Neurology and Neurosurgery. The findings were published in the 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.

 “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.”

The decompression surgery provides space for the swollen brain tissue in the critical phase. Surgeons cover the exposed brain with a protective membrane, and replace the removed bone flap once the swelling has gone down.

The analysis looked at 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 83 patients because of the clear benefits of the surgical procedure, with hemicraniectomies reducing the mortality rate from 70% to 33 percent.

Despite the difference in survival rates, people may hesitate to undergo the procedure. “Many patients do not accept the notion of survival with severe disability, especially in very old age,” Unterberg said. The researchers said that because of that, the procedure needs to be discussed with patients and their families.