{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:09:30Z","timestamp":1770750570642,"version":"3.50.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum W\u00fcrzburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>In malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14\u00a0cm (HC\u2009&gt;\u200914). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14\u00a0cm (HC\u2009\u2264\u200914).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC\u2009\u2264\u200914\u00a0cm vs. HC\u2009&gt;\u200914\u00a0cm). The primary outcome was modified Rankin scale (mRS) score\u2009\u2264\u20094 after 12\u00a0months. Secondary outcomes were in-hospital mortality, mRS\u2009\u2264\u20093 and mortality after 12\u00a0months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6\u00a0cm. 42 patients (32.3%) had HC\u2009&gt;\u200914. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC\u2009\u2264\u200914 27.6% vs. HC\u2009&gt;\u200914 36.6%, p\u2009=\u20090.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical trial registration information<\/jats:title>\n                <jats:p>German Clinical Trials Register (URL: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.drks.de\">https:\/\/www.drks.de<\/jats:ext-link>; Unique Identifier: DRKS00000624).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-023-11766-3","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T08:01:35Z","timestamp":1683792095000},"page":"4080-4089","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Large diameter hemicraniectomy does not improve long-term outcome in malignant infarction"],"prefix":"10.1007","volume":"270","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2339-8598","authenticated-orcid":false,"given":"Dominik","family":"Lehrieder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Peter","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Kassubek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Hecht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6tz","family":"Thomalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Michalski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Gattringer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katja E.","family":"Wartenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Schultze-Amberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hagen","family":"Huttner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joji B.","family":"Kuramatsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silke","family":"Wunderlich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Herbert","family":"Steiner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Weissenborn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzette","family":"Heck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albrecht","family":"G\u00fcnther","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hauke","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven","family":"Poli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Dohmen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Woitzik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"J\u00fcttler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Neugebauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the DESTINY-R (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY - Registry) Study Group and IGNITE (Initiative of German NeuroIntensive Trial Engagement) Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"11766_CR1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/NRL.0b013e3181f4ec88","volume":"17","author":"J Chung","year":"2011","unstructured":"Chung J, Bang OY, Lim YC, Park SK, Shin YS (2011) Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction. 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Lehrieder, H.P. M\u00fcller, J. Kassubek, G. Thomalla, D. Michalski, T. Gattringer, K.E. Wartenberg, J. Schultze-Amberger, H. Huttner, J.B. Kuramatsu, S. Wunderlich, H.H. Steiner, K. Weissenborn, S. Heck, H. Schneider, C. Dohmen, J. Woitzik and H. Neugebauer report no disclosures relevant to the manuscript; N. Hecht is Berlin Institute of Health Clinical Fellow, funded by Stiftung Charit\u00e9; S. Poli is coordinating investigator of Automatic PredICtion of Edema after Stroke (APICES) study (ClinicalTrials.gov unique identifier: NCT04057690); A. G\u00fcnther reports honoria from Pfizer, Bristol-Myers-Squibb, Boeringer Ingelheim, Daiichi Sankyo, Occlutech, Ipsen Pharma and Merz outside the submitted work; E. J\u00fcttler reports honoria from Pfizer, Bristol-Myers-Squibb, Boehringer Ingelheim, Daiichi Sankyo and Stryker outside the submitted work. He was Principle Investigator of DESTINY and DESTINY II, Co-Investigator of the pooled analyses of randomized hemicraniectomy trials and Co-author of guidelines on intracranial pressure treatment and treatment of space-occupying brain infarction.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The trial was registered in the German Registry for Clinical Studies (DRKS00000624). The ethics committee of the Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Campus Benjamin Franklin (EA4\/108\/09) and the local ethics committees of all participating centers approved this registry. Written informed consent was obtained from all patients or legal representatives.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}