Surve Rohini M, Sakrikar Gayatri, Kalgudi Pramod, Parthiban G, Chakrabarti Dhritiman
Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru, India.
J Clin Neurosci. 2025 Aug;138:111414. doi: 10.1016/j.jocn.2025.111414. Epub 2025 Jun 21.
Malignant ischemic stroke (MIS) is a life-threatening emergency requiring decompressive craniectomy (DC). Regional cerebral oxygenation (rScO) may provide valuable insights during the perioperative period of MIS. Primary objective of this study was to observe the correlation between baseline bilateral rScO (ipsilateral side (rScOI) and contralateral side (rScOC) with severity of the stroke assessed by National Institutes of Health Stroke Scale score (NIHSS) and Glasgow Coma Scale (GCS), and with discharge and 30 days functional outcome. Secondary objectives were to study the effect of DC on bilateral rScO changes and its correlation with the outcome.
This prospective observational study was conducted over a period of one year, and included adult patients of MIS requiring DC. NIHSS and GCS were assessed at admission, before and immediately after surgery. In operation theatre, baseline, during induction and at the end of the surgery, bifrontal rScO were recorded. Patient's outcome was assessed using Glasgow outcome scale extended (GOSE) and modified Rankin Score (mRS) at discharge and 30 days. Data analysed using R version 4.3.2.
A total of 35 patients were recruited. Baseline rScOI values, but not the rScOC, significantly correlated with admission GCS (r = 0.457, p = 0.007), and preoperative NIHSS (r = -0.384, p = 0.025). Baseline rScO did not correlate with the outcome. Following DC, significant improvement was observed in rScOI (p = 0.03) and rScOC (p = 0.02) with changes in rScOC, but not rScOI, showed a strong positive correlation with discharge GOSE (r = 0.734, p = 0.000) and 30-day GOSE (r = 0.455, p = 0.02), and a negative correlation with discharge (r = -0.641, p = 0.000) and 30-day mRS (r = -0.485, p = 0.01).
Non-invasive cerebral oxygenation correlates with the severity of stroke, helps to monitor the changes following DC and also to predict the short-term functional outcome, suggesting its utility during the perioperative course in MIS patients.
恶性缺血性卒中（MIS）是一种危及生命的急症，需要进行减压颅骨切除术（DC）。局部脑氧合（rScO）可能在MIS围手术期提供有价值的见解。本研究的主要目的是观察基线双侧rScO（患侧（rScOI）和对侧（rScOC））与通过美国国立卫生研究院卒中量表评分（NIHSS）和格拉斯哥昏迷量表（GCS）评估的卒中严重程度之间的相关性，以及与出院时和30天功能结局的相关性。次要目的是研究DC对双侧rScO变化的影响及其与结局的相关性。
这项前瞻性观察性研究进行了一年，纳入了需要进行DC的MIS成年患者。在入院时、手术前和手术后立即评估NIHSS和GCS。在手术室中，记录基线、诱导期间和手术结束时的双额rScO。使用格拉斯哥扩展结局量表（GOSE）和改良Rankin量表（mRS）在出院时和30天时评估患者的结局。使用R版本4.3.2进行数据分析。
共招募了35名患者。基线rScOI值而非rScOC值与入院时的GCS显著相关（r = 0.457，p = 0.007），以及术前NIHSS（r = -0.384，p = 0.025）。基线rScO与结局无关。DC后，rScOI（p = 0.03）和rScOC（p = 0.02）有显著改善，rScOC的变化而非rScOI的变化与出院时的GOSE（r = 0.734，p = 0.000）和30天GOSE（r = 0.455，p = 0.02）呈强正相关，与出院时（r = -0.641，p = 0.000）和30天mRS（r = -0.485，p = 0.01）呈负相关。
无创脑氧合与卒中严重程度相关，有助于监测DC后的变化，并预测短期功能结局，表明其在MIS患者围手术期过程中的实用性。
