10-year institutional retrospective case series of decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI)

Background: A 10-year (2005–2015) retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken. Methods: Patient demographics, comorbidities, pre- and postoperative neurologic state, operative timescales, craniectomy dimensions, and Glasgow Outcome Scale scores were analyzed. Results: Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% (n = 7). Seventeen patients (42.5%) were male, with a mean age of 43 years (range: 16–64 years). Patients who survived had a lower mean age of 41 years (range: 16–59 years) than those who did not of 50 years (range: 42–63 years). The modal ictal and preoperative Glasgow Coma Scale scores were 14 (range: 5–15) and 7 (range: 3–12), which corresponded to motor scores of 6 and 5, respectively. The mean time from ictus to admission to the Institute of Neurological Sciences (INS) was 23.5 hours (range: 0.5–66 hours) and from INS admission to decompression 7.5 hours (range: 0.5–46 hours). Approximately 60% of patients had an “early” craniectomy (under 48 hours from ictus) and 60% of patients had a craniectomy performed less than 24 hours from INS admission. The mean maximum anteroposterior craniectomy diameter measured 13 cm (range: 10.93–15.12 cm) and the mean surface area was 92.68 cm2 (range: 76.14–124.42 cm2). Overall 80% of patients had a modal Glasgow Outcome Scale score of 3 (range: 2–5) at discharge, 3 months, 6 months, 9 months, and 12 months. The median length of stay was 3 days (range: 6 hours to 11 days) for nonsurvivors and 13 days (range: 1–365 days) for survivors. Conclusion: Decompressive craniectomy for mMCAI is suitable in selected patients, and the local practice is consistent with current evidence