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

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-21 DOI:10.1016/j.jocn.2025.111414

Rohini M. Surve , Gayatri Sakrikar , Pramod Kalgudi , G. Parthiban , Dhritiman Chakrabarti

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引用次数: 0

Abstract

Background

Malignant ischemic stroke (MIS) is a life-threatening emergency requiring decompressive craniectomy (DC). Regional cerebral oxygenation (rScO₂) may provide valuable insights during the perioperative period of MIS. Primary objective of this study was to observe the correlation between baseline bilateral rScO₂ (ipsilateral side (rScO₂I) and contralateral side (rScO₂C) 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 rScO₂ 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 rScO₂ 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 rScO₂I values, but not the rScO₂C, significantly correlated with admission GCS (r = 0.457, p = 0.007), and preoperative NIHSS (r = -0.384, p = 0.025). Baseline rScO₂ did not correlate with the outcome. Following DC, significant improvement was observed in rScO₂I (p = 0.03) and rScO₂C (p = 0.02) with changes in rScO₂C, but not rScO₂I, 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.

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区域脑氧饱和度在恶性前循环缺血性脑卒中患者减压颅骨切除术前后的预后价值——一项前瞻性观察研究

恶性缺血性脑卒中（MIS）是一种危及生命的紧急情况，需要进行颅骨减压切除术（DC）。区域脑氧合（rScO2）可为MIS围手术期提供有价值的信息。本研究的主要目的是观察基线双侧rScO2(同侧（rScO2I）和对侧（rScO2C）与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、出院和30天功能结局之间的相关性。次要目的是研究DC对双侧rScO2变化的影响及其与预后的相关性。方法：这项前瞻性观察研究为期一年，纳入了需要DC治疗的MIS成年患者。在入院时、术前和术后立即评估NIHSS和GCS。在手术室，基线，诱导时和手术结束时，记录双额rScO2。在出院和30天时使用格拉斯哥结局量表扩展（GOSE）和改进的Rankin评分（mRS）评估患者的预后。数据分析使用R版本4.3.2。结果共纳入35例患者。基线rScO2I值与入院GCS （r = 0.457, p = 0.007）和术前NIHSS （r = -0.384, p = 0.025）显著相关，而rScO2C值与入院GCS （r = 0.457, p = 0.007）和术前NIHSS （r = -0.384, p = 0.025）无关。基线rScO2与结果无关。DC后，rScO2I （p = 0.03）和rScO2C （p = 0.02）有显著改善，rScO2C有变化，但rScO2I无变化，与出院时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GOSE （r = -0.641, p = 0.000）和30天mRS （r = -0.485, p = 0.01）呈负相关。结论无创脑氧合与脑卒中严重程度相关，有助于监测DC后脑氧合的变化，预测短期功能结局，提示其在MIS患者围手术期的应用价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.