Is decompressive craniectomy for malignant middle cerebral artery territory infarction of any benefit for elderly patients?

Abstract

Background: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients who present with malignant MCA territory infarction and to compare functional outcome in elderly patients with younger patients.

Methods: Patients with malignant MCA territory infarction treated in our hospital between January 1997 and March 2003 were included in this retrospective analysis. The National Institutes of Health Stroke Scale (NIHSS) assessed neurologic status at admission, operation, and at 1 week after surgery. All patients were followed up for assessment of functional outcome by the Barthel Index (BI) and the modified Rankin Scale (RS) at 3 to 9 months after infarction.

Results: Twenty-five patients underwent decompressive craniectomy. The mortality was 7.7% in younger patients (ages <60 years) compared with 33.3% in elderly patients (ages >/=60 years) (P > .05). All patients had significant decrease of NIHSS after surgery (P < .001). At follow-up, younger patients who received surgery had significantly better outcome with mean BI of 75.42 and Rankin score of 3.00; however, none of the elderly survivors had a BI score above 60 or a Rankin score below 4.

Conclusion: Decompressive craniectomy in younger patients with malignant MCA territory infarction improves both survival rates and functional outcomes. Although survival rates were improved after surgery in elderly patients, functional outcome and level of independence were poor.