Abstract
Objective: Decompressive hemicraniectomy (DC) has been shown to reduce mortality among patients with malignant middle cerebral artery ( MCA) infarction in short term. The present study aimed at studying the long term functional outcome of patients undergoing DC for malignant MCA infarctions. Methods: All patients malignant MCA infarction requiring DC were prospectively enrolled. Patients meeting the inclusion criteria but not undergoing surgery due to any reason were taken as controls. Aphasia testing using was done using Western Aphasia Battery. Modified Rankin Scale (mRS) was done at 3, 6 and12 months to grade functional outcome. mRS ≤ 3 was defined as a good outcome. Results: 60 patients were enrolled during the study period. Mean age was 49.6 years with 72% males. 36 patients (60%) underwent decompressive hemicraniectomy (surgery group) and 24 (40%) received best medical management only (medical group). Mean delay to surgery from time of onset of symptoms was 56 hours (9-148). One year follow up completed for 57 patients and 35 patients (61.4%) died over a period of 1year. Significantly high mortality was noted in the control group at discharge, 3, 6 & 12 months. Cumulative risk of death was 83% in controls compared to 38% in surgical group at 1 year. 2.78% (1/36),16.67% (6/36) and 20% (7/35) patients achieving good outcome at 3, 6 and 12 months in the surgery group and none in controls. Repeated ANOVA showed progressive improvement over time from 3 to 6 months (p< 0.01), 3 months to 1year (p< 0.001), and 6 months to 1 year (p<0.019). Mean aphasia quotient improved progressively over time. Conclusions: Decompressive hemicraniectomy leads to a increased and functionally better survival compared to medical management alone. The outcome assessment at 3 months underrepresants the benefits in trials. For life threatening strokes it is prudent to make assessment at longer intervals. There is progressive improvement in aphasia over time in the surgically survived group
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