Decompressive Hemicraniectomy in the Treatment of Malignant Middle Cerebral Artery Infarction

Abstract Background: Malignant middle cerebral artery infarctions affecting about 10% of stroke patients. Formed of huge space-occupying infarctions with extensive edema which lead to herniation, and usually death. Treatment includes medical treatment in addition to decompressive hemicraniectomy associated with duroplasty in many cases. Decompressive craniectomy has a great effect in reduction of mortality rates and improving the functional outcome of the patients. Aim of Study: We reviewed the outcome of decompressive hemicraniectomy in the treatment of Malignant Middle Cer-ebral Artery infarction. Patients and Methods: The study includes 14 patients of malignant middle cerebral artery infarctions operated upon by decompressive surgery (from January 2015 to August 2018). We evaluated the outcome by estimation of the mortality rate after one month, Glasgow Outcome Score (GOS) on leaving the hospital, at 3 months, and 6 months by modified Rankin scale (mRS). Results: Decompressive craniectomy leads to decrease in mortality rate at 30 days and acceptable GOS outcome at discharge. At 3 months and 6 months good functional outcome based on mRS occurred in cases of the infarction volume below than 250ml, midline shift below 10mm, good Glasgow Coma Scale (GCS) score before surgery and rapid surgical intervention (within 24 hours). Conclusion: Decompressive craniectomy gets great func-tional outcome in cases of young cases with acceptable GCS score before surgery, fair radiological pictures, and operated upon in less than 24 hours of onset.