Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke : a case-based review

Article Article scientifique Revue de la littérature Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke : a case-based review eng 2023-07-26 2023-09 author Ledermann Audrey Neonatology and Pediatric Intensive Care Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 704779 author Bartoli Andréa Neurosurgery Unit, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 840772 author Gebistorf Fabienne Neonatology and Pediatric Intensive Care Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 540601 author Beghetti Maurice Pediatric Cardiology Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 31865 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Sologashvili Tornike Cardiovascular Surgery Unit, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 807807 Département de chirurgie (CHIRU) author Rebollo Polo Monica 0000-0001-9756-9671 Pediatric Radiology Unit, Department of Radiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 410125 author Fluss Joel Victor 0000-0002-6413-162X Pediatric Neurology Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. joel.fluss@hcuge.ch. 28801 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) 2377-2389 10.1007/s00381-023-06086-w 37493722 0256-7040 PMC10432330 https://link.springer.com/article/10.1007/s00381-023-06086-w Purpose: Malignant stroke is a life-threatening emergency, with a high mortality rate (1-3). Despite strong evidence showing decreased morbidity and mortality in the adult population, decompressive hemicraniectomy (DCH) has been scarcely reported in the pediatric stroke population, and its indication remains controversial, while it could be a potential lifesaving option. Methods and results: We performed an extensive literature review on pediatric malignant arterial ischemic stroke (pmAIS) and selected 26 articles reporting 97 cases. Gathering the data together, a 67% mortality rate is observed without decompressive therapy, contrasting with a 95.4% survival rate with it. The median modified Rankin score (mRS) is 2.1 after surgery with a mean follow-up of 31.8 months. For the 33% of children who survived without surgery, the mRS is 3 at a mean follow-up of 19 months. As an illustrative case, we report on a 2-year-old girl who presented a cardioembolic right middle cerebral artery stroke with subsequent malignant edema and ongoing cerebral transtentorial herniation in the course of a severe myocarditis requiring ECMO support. A DCH was done 32 h after symptom onset. At the age of 5 years, she exhibits an mRS of 3. Conclusion: Pediatric stroke with malignant edema is a severe condition with high mortality rate if left untreated and often long-lasting consequences. DCH might minimize the vicious circle of cerebral swelling, increasing intracranial pressure and brain ischemia. Our literature review underscores DCH as an efficient therapeutic measure management of pmAIS even when performed after a significant delay; however, long-lasting morbidities remain high. Craniectomy Malignant edema Pediatric stroke Adult Female Humans Child Child, Preschool Decompressive Craniectomy / methods Treatment Outcome Ischemic Stroke / surgery Stroke / etiology Stroke / surgery Infarction, Middle Cerebral Artery / complications Infarction, Middle Cerebral Artery / surgery Edema Dewey 616.8 Dewey 616.0757 Dewey 617 Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 61 Département des neurosciences cliniques 226 57 Département de chirurgie 222 62 Département de radiologie et informatique médicale 227 false 150 L'imagerie cérébrale 184 179 L'hypertension pulmonaire (pédiatrie) 228 Child's nervous system 39 9 022efe83-368c-4992-be24-5350608a41e3 Article (Published version) Public Article_scientifique_from_europePmc.pdf 1020594 application/pdf CC BY-4.0 712072658ce3e1124053a8414a4cf6cae7c502682e334f8f107f920b70e4af79 openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke : a case-based review	Child's nervous system			2023	79	240

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Ledermann, Audrey