Ahi Evran Medical Journal (Aug 2024)
Decompressive Craniotomy for Malignant Middle Cerebral Artery Infarction: A Prospective Cohort Study
Abstract
Purpose: For malignant middle cerebral artery (MCA) infarctions, the mortality rate is very high. Although decompressive craniotomy (DC) appears to reduce mortality, the quality of life remains a current topic of debate. We aimed to present the outcomes of patients with malignant MCA infarctions treated medically or surgically at our high-volume tertiary care hospital. Materials and Methods: The study was designed as a prospective cohort. Decompressive craniotomy (DC) was offered to all patients meeting the criteria, while those who declined were included in the control group receiving medical treatment. Patients were evaluated preoperatively and early postoperatively and also in the follow-ups at 1, 3, 6, and 12 months. Result: Forty-two patients were included in the study (17/surgery, 25/medical). Survival rates of those who received DC in each follow-up period were higher than those who received only medical treatment. This difference was also significant at the postoperative 1st, 3rd, and 6th months. In addition, the modified Rankin-Scale examination showed that DC was superior in each control period. Conclusion: In our study, the higher mortality among patients who underwent DC, albeit lower than those treated with medical therapy alone, could be attributed to poorer neurological status at the time of surgery compared to other series. The indication for surgery should not wait until the patient's condition deteriorates significantly. Therefore, it is crucial to promptly report any neurological deterioration observed during early period to the neurosurgeon. Referring patients who are at risk of neurological decline to a neurosurgery clinic could serve as an alternative solution.
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