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. 2014 Feb 28:3:115.
doi: 10.1186/2193-1801-3-115. eCollection 2014.

Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction

Abdolkarim Rahmanian  1 , Babak Seifzadeh  1 , Ali Razmkon  2 , Peyman Petramfar  3 , Juri Kivelev  4 , Ehsan-Ali Alibai  1 , Juha Hernesniemi  4
Affiliations

Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction

Abdolkarim Rahmanian et al. Springerplus. .

Abstract

Background: Malignant cerebral infarction is a well-recognized disease, comprising 10-15% of all cases with cerebral infarction and causing herniation and death in 80% of cases. In this study, we compare the effects of decompressive craniectomy versus conventional medical treatment on mortality rate and functional and neurological outcome in patients with malignant MCA infarction.

Methods: We performed a prospective case-control study on 60 patients younger than 80years of age suffering malignant MCA cerebral infarction. The case group underwent decompressive craniectomy in addition to routine aggressive medical care; while the control group received routine medical treatment. Patient outcome was assessed using Glasgow outcome scale and modified Rankin scale within three months of follow-up. The data were analyzed by SPSS version 16.0 software using Chi Square, One-way ANOVA and Mann-Whitney tests.

Results: There were 27 male and 33 female patients with a mean age of 60.6 years (SD = 12.3). Glasgow outcome scale score averaged 2.93 in the surgical versus 1.53 in the medical group; this difference was significant (p = 0.001). Outcome in modified Rankin scale was also significantly lower in the surgical (3.27) versus medical (5.27) group (p < 0.001). Surgery could decrease the mortality rate about 47%.

Conclusion: In this study, decompressive craniectomy could decrease mortality rate, and improve neurological and functional outcome, and decrease long-term disability in patients with malignant MCA infarction.

Keywords: Cerebral infarction; Decompressive craniectomy; Middle cerebral artery.

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Figures

Figure 1
Figure 1
Outcome at 3 months follow-up based on GOS scale.
Figure 2
Figure 2
Outcome at three months follow- up based on MRS scale.
See this image and copyright information in PMC

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