Title: Role and Assessment of Outcome of Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction in Patients: A Hospital Based Retrospective Study
Authors: Govind Mangal, Uday Bhaumik, Anis Jukkarwala
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.72
Abstract
Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%.
Aim: To determine the role of decompressive craniectomy in patients presenting malignant MCA infarction ant to assess its outcome in patients.
Material and Method: This retrospective study included a sample of 25 patients with malignant MCA infarction who underwent decompressive craniectomy in the Department of Neurology at Geetanjali Medical College and Hospital during the period of 1st January 2016 – 31st January 2017. Clinical characteristics included preoperative clinical condition, timing of surgery, cause of infarction, location, and extension of infarction was analyzed. In addition, the time delay from the onset of symptoms to surgery and preoperative signs of herniation and their relation to the final outcome was analyzed. The final outcome was assessed in terms of mortality and scores such as modified Rankin scale (mRS). Functional outcome was divided into two groups: Favorable outcome (mRS score 0–3) versus poor outcome (mRS score 4–6).
Result: 25 patients of age between 21 and 80 years with mean age of 53.96 ± 10.09 years were analyzed. 64% of the patients were of age below 60 years. 48% patients were operated within 48 hours and 52% were operated after 48 hrs. mRS between 0-3 was observed at discharge in both which was not statistically significant. But according to age, 33.33% patients with age more than 60 years and 81.25% patients with age less than 60 years had mRS 0-3 which was statistically significant.
Conclusion: Decompressive craniectomy in malignant cerebral artery infraction had reduced the mortality especially in patients of age less than 60 years and those who operated within 48 hours of stroke. Thus there is no reason to deny the surgery.
Keywords: Decompressive craniectomy, malignant, infraction, modified Rankin Score, Glasgow coma scale.
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