Scopelliti Giuseppe, Henon Hilde, Masheka-Cishesa Olivier, Labreuche Julien, Kuchcinski Gregory, Aboukais Rabih, Cordonnier Charlotte, Casolla Barbara
Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France.
Neurology Unit, Luigi Sacco University Hospital, Milan, Italy.
Eur J Neurol. 2025 Jan;32(1):e16492. doi: 10.1111/ene.16492. Epub 2024 Oct 30.
Decompressive hemicraniectomy (DH) improves survival and functional outcome in large middle cerebral artery (MCA) infarcts. However, long-term cognitive outcomes after DH remain underexplored. In a cohort of patients with large right-hemisphere MCA infarction undergoing DH, we assessed the rates of long-term cognitive impairment over 3-year follow-up.
We prospectively evaluated consecutive patients included in the Lille Decompressive Surgery Database (May 2005-April 2022) undergoing DH according to existing guidelines for large hemisphere MCA infarction. We included patients with right-sided stroke and screened with the Mini-Mental State Examination (MMSE) in at least one of the prespecified follow-ups (3-month, 1-year, 3-year). Cognitive impairment was defined as an MMSE score < 24. We included only right-hemisphere strokes to avoid testing biases related to severe aphasia. We compared clinical and neuroimaging data in patients with and without cognitive impairment.
Three hundred four patients underwent DH during the study period. Among 3-month survivors, 95 had a right-hemisphere stroke and underwent at least one cognitive screening (median age = 51 years, 56.8% men). Forty-four patients (46.3%) exhibited cognitive impairment at least once during the 3-year follow-up. Baseline characteristics did not significantly differ between patients with and without cognitive impairment. Regarding long-term temporal trends, cognitive impairment was observed in 23 of 76 (30.3%), 25 of 80 (31.3%), and 19 of 66 (28.8%) patients at 3-month, 1-year, and 3-year follow-up, respectively, and it was associated with higher rates of functional disability (all p < 0.05).
The persistently high rates of cognitive impairment after DH highlight the importance of cognitive monitoring to improve the long-term management of survivors.
减压性半球切除术（DH）可提高大脑中动脉（MCA）大面积梗死患者的生存率和功能预后。然而，DH术后的长期认知结局仍未得到充分研究。在一组接受DH的右侧大脑半球MCA大面积梗死患者中，我们评估了3年随访期内长期认知障碍的发生率。
我们根据现有的大脑半球MCA大面积梗死指南，对里尔减压手术数据库（2005年5月至2022年4月）中连续接受DH的患者进行了前瞻性评估。我们纳入了右侧卒中患者，并在至少一次预定随访（3个月、1年、3年）中用简易精神状态检查表（MMSE）进行筛查。认知障碍定义为MMSE评分<24分。我们仅纳入右侧半球卒中患者，以避免与严重失语相关的测试偏倚。我们比较了有认知障碍和无认知障碍患者的临床和神经影像学数据。
在研究期间，304例患者接受了DH。在3个月存活的患者中，95例为右侧半球卒中并接受了至少一次认知筛查（中位年龄=51岁，男性占56.8%）。44例患者（46.3%）在3年随访期间至少出现过一次认知障碍。有认知障碍和无认知障碍患者的基线特征无显著差异。关于长期时间趋势，在3个月、1年和3年随访中，分别有76例中的23例（30.3%）、80例中的25例（31.3%）和66例中的19例（28.8%）出现认知障碍，且与更高的功能残疾率相关（所有p<0.05）。
DH术后认知障碍的持续高发生率凸显了认知监测对改善幸存者长期管理的重要性。
