Abstract
Decompressive hemicraniectomy (DHC) has been shown to improve clinical outcome in cases of malignant infarct but its indications have not been well classified. This study focuses on patients who suffered malignant middle cerebral artery (MMCA) infarct with subsequent hemorrhagic conversion and were admitted with mild brain injury (initial Glasgow Coma Scale≥13). Survival rates of MMCA infarct patients with hemorrhagic conversion who underwent DHC were compared with those treated with medical management only. Hypothesis: Patients admitted for MMCA infarct with a Glasgow Coma Scale ≥13 who develop hemorrhagic conversion have improved survivability when DHC is performed. Methods: Retrospective review was performed on all cases consulted for neurological surgery from 2007-2012 at University Hospital. Patients were selected on the criteria of MMCA infarct on admission with subsequent development of hemorrhage conversion. Patients who underwent DHC had to have the hemorrhagic conversion prior to surgery for inclusion. The primary endpoint was mortality. Fisher’s Exact Test and odds ratio were performed on patients with MMCA infarct and hemorrhagic conversion comparing patient mortality with DHC to that without. Results: In total, 91 MMCA infarct patients were referred to neurological surgery, 33 with an initial Glasgow Coma Scale >13. Of those, 36% (12/33) had hemorrhagic conversion. Six patients underwent DHC with a survival rate of 6/6. Patients treated medically had a survival rate of 33%. The Fisher’s Exact Test showed statistical significance (p<0.05) for improved survival rate and Odds ratio confirmed reduced mortality within a 95% confidence interval of hemorrhagic conversion following MMCA infarct when DHC was performed using GraphPad InStat 3.10. Conclusion: A statistically significant increase in survival has been found with use of DHC for MMCA infarct with subsequent hemorrhagic conversion in patients with a high admission Glasgow Coma Scale.
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