10-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction (mMCAI)

Abstract

A 10-year (2005-2015) retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken. Patient demographics, comorbidities, pre- and postoperative neurologic state, operative timescales, craniectomy dimensions, and Glasgow Outcome Scale scores were analyzed. Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% (n= 7). Seventeen patients (42.5%) were male, with a mean age of 43 years (range: 16-64 years). Patients who survived had a lower mean age of 41 years (range: 16-59 years) than those who did not of 50 years (range: 42-63 years). The modal ictal and preoperative Glasgow Coma Scale scores were 14 (range: 5-15) and 7 (range: 3-12), which corresponded to motor scores of 6 and 5, respectively. The mean time from ictus to admission to the Institute of Neurological Sciences (INS) was 23.5 hours (range: 0.5-66 hours) and from INS admission to decompression 7.5 hours (range: 0.5-46 hours). Approximately 60% of patients had an "early" craniectomy (under 48 hours from ictus) and 60% of patients had a craniectomy performed less than 24 hours from INS admission. The mean maximum anteroposterior craniectomy diameter measured 13 cm (range: 10.93-15.12 cm) and the mean surface area was 92.68 cm2 (range: 76.14-124.42 cm2). Overall 80% of patients had a modal Glasgow Outcome Scale score of 3 (range: 2-5) at discharge, 3 months, 6 months, 9 months, and 12 months. The median length of stay was 3 days (range: 6hours to 11 days) for nonsurvivors and 13 days (range: 1-365 days) for survivors. Decompressive craniectomy for mMCAI is suitable in selected patients, and the local practice is consistent with current evidence.