Hemicraniectomy, a surgical procedure to relieve pressure in the brain, is often performed for severe strokes. However, concerns exist regarding its use in dominant hemisphere strokes, which control language and other crucial functions. This meta-analysis examines whether stroke laterality (dominant vs. nondominant) affects outcomes after hemicraniectomy.
Examining Stroke Laterality and Hemicraniectomy Outcomes
A comprehensive literature search identified 51 studies, including observational studies, non-randomized trials, and randomized controlled trials, involving 2361 patients who underwent hemicraniectomy for middle cerebral artery infarction. The primary outcome measured was severe disability or death. The analysis compared outcomes in patients with dominant hemisphere strokes versus those with nondominant hemisphere strokes, focusing on both short-term (≤ 3 months) and long-term (> 3 months) recovery.
Findings Challenge Conventional Concerns
The meta-analysis revealed no significant association between dominant stroke laterality and unfavorable outcomes in either the short-term (OR 1.00, 95% CI 0.69‒1.45) or long-term (OR 1.01, 95% CI 0.76‒1.33). This suggests that patients with dominant hemisphere strokes experience similar recovery after hemicraniectomy as those with nondominant strokes.
To ensure the robustness of the findings, several sensitivity analyses were conducted. These included excluding studies with specific limitations like focusing solely on mortality, including second-look strokectomies, having low quality, or possessing small sample sizes. Additionally, comparisons were made between patient populations from North America/Europe versus Asia/South America. Importantly, the results remained consistent across all sensitivity analyses, further supporting the primary conclusion.
Implications for Treatment Decisions
While the evidence quality was graded as very low for short-term outcomes and low for long-term outcomes, this meta-analysis provides valuable insights. The findings do not support withholding hemicraniectomy solely based on stroke laterality. This suggests that concerns about worse outcomes in dominant hemisphere stroke patients may be unwarranted. Decisions regarding hemicraniectomy should be made on a case-by-case basis, considering individual patient factors rather than relying solely on stroke location.
Conclusion: Laterality May Not Be a Determining Factor
This comprehensive analysis suggests that dominant hemisphere stroke location does not significantly impact outcomes after hemicraniectomy. Future research with higher-quality evidence is needed to confirm these findings. However, the current results suggest that clinicians should not exclude patients from potentially life-saving hemicraniectomy based solely on the side of the brain affected by the stroke.
