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 h while 10 patients were operated upon after 48 h. 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.
Highlights
Decompressive craniectomy for malignant middle cerebral artery (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
Patients suffering from large hemispheric infarction (LHI), which is known as malignant middle cerebral artery (MCA) infarction, have an increased incidence of significant disability and mortality [1]
In spite of maximum medical therapy such as intracranial pressure (ICP) lowering measures, hypothermia, and controlled hyperventilation, malignant MCA infarction could result in death in 70–80% of cases; most survivors are left with long-term disability [2, 3]
Summary
Patients suffering from large hemispheric infarction (LHI), which is known as malignant middle cerebral artery (MCA) infarction, have an increased incidence of significant disability and mortality [1]. They mainly present with hemiparalysis and severe sensory deficits with aphasia if the dominant hemisphere is affected. The role of decompressive craniectomy in the management of malignant MCA infarction is debatable by many authors It was initially developed as a life-saving procedure for patients suffering from malignant hemispheric infarction, but the survivors remained with severe disability which formed a serious concern [5]
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