Decompressive hemicraniectomy in malignant MCA infarct in a tertiary centre

Abstract

IntroductionDecompressive hemicraniectomy as a surgical treatment for cerebral edema has been performed since many years for several different pathologies, including malignant middle cerebral artery infarct. In this article we share our experience with decompressive hemicraniectomy in malignant MCA infarct. Materials and methodsFifty two patients who underwent decompressive hemicraniectomy after malignant MCA infarction between January 2011 and January 2015 at tertiary care hospital were analysed. Preoperative clinical status, radiological parameters, timing of surgery, involvement and extension of infarction were recorded. The outcome was assessed in terms of mortality, Barthel index and GOS. ResultsFifty two patients who underwent decompressive hemicraniectomy for malignant MCA infarct were analysed in the study. The mean age of the cohort was 59+/−10.8 years ranging from 20 to 80 years. Thirty (57.6%) patients had good functional recovery, 12 (23%) patients died. The overall mortality rate was 23% which was comparable to other studies in the literature. Patients <50 years with admission GCS >8 and non dominant hemispheric stroke had a better outcome in this study. ConclusionDecompressive hemicraniectomy has reduced mortality and morbidity especially in people aged below 50 years. Neurological benefit was seen in patients operated within 48 hrs of malignant MCA stroke as well as those operated outside 48 hrs of stroke.