Prognostic value of regional cerebral oxygen saturation pre and post decompressive craniectomy in patients with malignant anterior circulation ischemic stroke - a prospective observational study.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.