Decompressive craniectomy in malignant hemispheric infarction: favorable outcome and disability

Abstract

ContextPatients with malignant middle cerebral artery (MCA) infarction are prone to a mortality rate of 70–80%. Decompressive craniectomy (DC) has been used as an important treatment modality to control refractory intracranial hypertension.AimIn this study, we aimed to evaluate the impact of DC in reducing mortality rate and improving the functional outcome in the patients who underwent DC surgery for malignant MCA infarctionSettings and designThe prospective clinical case study included 24 patients with refractory intracranial hypertension due to malignant MCA infarctionPatients and methodsAll patients enrolled in the study have refractory intracranial hypertension due to malignant MCA infarction; they were allocated to undergo decompressive craniectomy between 2014 and 2017. Each patient was evaluated clinically using the Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS).ResultsAll patients on admission have the GCS of 5–12 score (mean 8). Fourteen patients underwent DC in the first 48\u2009h while 10 patients were operated upon after 48\u2009h. Postoperatively, two patients (9%) had a score of 3 on the modified Rankin Scale, six patients (25%) had a score of 4, and eight patients (33%) had a score of 5. Mortality occurred in eight patients (33%) with the worst score of 6. Similar unfavorable outcome was reported at 6- and 12-month follow-up with different degrees of disability.ConclusionDecompressive craniectomy for malignant MCA infarction has an effective role in decreasing the mean intracranial pressure, reducing the mortality rate, and increasing the number of patients with a favorable outcome.