Sáez-Alegre Miguel, García-Feijoo Pablo, Millán Pablo, Vivancos Sánchez Catalina, Rodríguez Domínguez Víctor, García Nerín Jorge, Isla Guerrero Alberto, Gandía-González María Luisa
Department of Neurosurgery, Hospital La Paz Madrid, Madrid, Spain.
Department of Intensive Care Medicine, Hospital La Paz Madrid, Madrid, Spain.
Front Neurol. 2021 Feb 22;12:632036. doi: 10.3389/fneur.2021.632036. eCollection 2021.
SARS-CoV2 infection can lead to a prothrombotic state. Large vessel occlusion, as well as malignant cerebral stroke have been described in COVID-19 patients. In the following months, given the increase in COVID-19 cases, an increase in malignant cerebral SARS-CoV2 associated strokes are expected. The baseline situation of the patients as well as the risk of evolution to a serious disease due to the virus, depict a unique scenario. Decompressive craniectomy is a life-saving procedure indicated in patients who suffer a malignant cerebral stroke; however, it is unclear whether the same eligibility criteria should be used for patients with COVID-19. To our knowledge seven cases of decompressive craniectomy and malignant cerebral stroke have been described to date. We report on a 39-year-old female with no major risk factors for cerebrovascular disease, apart from oral contraception, and mild COVID-19 symptoms who suffered from left hemispheric syndrome. The patient underwent endovascular treatment with stenting and afterward decompressive craniectomy due to a worsening neurological status with unilateral unreactive mydriasis. We present the case and provide a comprehensive review of the available literature related to the surgical treatment for COVID-19 associated malignant strokes, to establish whether the same eligibility criteria for non-COVID-19 associated strokes should be used. Eight patients, including our case, were surgically managed due to malignant cerebral stroke. Seven of these patients received decompressive craniectomy, and six of them met the eligibility criteria of the current stroke guidelines. The mortality rate was 33%, similar to that described in non-COVID-19 cases. Two patients had a left middle cerebral artery (MCA) and both survived after decompressive craniectomy. Our results support that decompressive craniectomy, using the current stroke guidelines, should be considered an effective life-saving treatment for COVID-19-related malignant cerebral strokes.
严重急性呼吸综合征冠状病毒2（SARS-CoV2）感染可导致血栓前状态。新冠病毒病（COVID-19）患者中已出现大血管闭塞以及恶性脑卒中等情况。在接下来的几个月里，鉴于COVID-19病例的增加，预计与SARS-CoV2相关的恶性脑卒中将有所增加。患者的基线情况以及因该病毒演变为重症疾病的风险，描绘了一种独特的情形。减压性颅骨切除术是一种用于救治恶性脑卒中患者的挽救生命的手术；然而，对于COVID-19患者是否应采用相同的入选标准尚不清楚。据我们所知，迄今为止已报道了7例减压性颅骨切除术和恶性脑卒中的病例。我们报告了一名39岁女性，除口服避孕药外无其他脑血管疾病主要危险因素，患有轻度COVID-19症状，出现左半球综合征。由于神经状态恶化伴单侧瞳孔散大固定，该患者先接受了支架血管内治疗，随后进行了减压性颅骨切除术。我们展示该病例并对与COVID-19相关恶性脑卒中手术治疗的现有文献进行全面综述，以确定是否应采用与非COVID-19相关脑卒中相同的入选标准。包括我们的病例在内，共有8名患者因恶性脑卒中接受了手术治疗。其中7名患者接受了减压性颅骨切除术，6名符合当前脑卒中指南的入选标准。死亡率为33%，与非COVID-19病例报道的相似。两名患者患有左侧大脑中动脉（MCA）闭塞，均在减压性颅骨切除术后存活。我们的结果支持，按照当前脑卒中指南进行减压性颅骨切除术应被视为治疗COVID-19相关恶性脑卒中的一种有效的挽救生命的治疗方法。
