Malignant Middle Cerebral Artery Infarction; indications and outcome of Decompressive Craniectomy

Dr. Ramanjulu M.; Dr. Venkateswara Rao C.; Dr. Ananth M. L.; Dr.Ram Balaji Naik G.

Volume : IV, Issue : VI, June - 2015

Malignant Middle Cerebral Artery Infarction; indications and outcome of Decompressive Craniectomy

Dr. Ramanjulu M. , Dr. Venkateswara Rao C. , Dr. Ananth M. L. , Dr. Ram Balaji Naik G.

Abstract :

Background: Malignant cereal infarction is a well recognized disease, comprising 10–15% of all cases with cereal infarction and causing herniation and death in 80% of cases. Several studies reported an improved outcome in patients presenting with malignant cereal infarction treated by decompressive craniectomy. In this study we are reviewing the indications and neurological outcome in patient with malignant cereal infarction after decompressive craniectomy and the literature reviewed. Methods: This retrospective study included 30 patients who underwent decompressive craniectomy after malignant cereal infarction between January 2010 and April 2015 at Department of Neurosurgery Government General Hospital Kurnool, Andhra Pradesh, India. Clinical neurological presentation was evaluated using the Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS). The infarct territory was evaluated by CT scan and in some cases by MRI. Demographic characteristics included preoperative clinical condition, timing of surgery, cause, location, extent of cereal infarction, time delay from the onset of symptoms to surgery and preoperative signs of herniation and their relation to the final outcome were analyzed. All patients underwent decompressive craniectomy in addition to routine aggressive medical care. Patient outcome was assessed using Glasgow outcome scale and mRS score on discharge and follow–up examination. Results: There were 24 males and 6 females, with mean age 54 years. The preoperative clinical condition according to median GCS score was of 5.5.Median mRS score on admission was 5. The time in hours to surgery after onset of symptoms was 6 to 48 hours with mean of 24 hours. .Twelve patients (36%) underwent early surgery (within 24 hours) and 21(66%) suffered non dominant stroke .Glasgow outcome scale score averaged more than 3. Median mRS score was 1.5 at follow–up examination. The overall mortality was 36% (12 patients).12 patients had favourable outcome (mRS<3) Conclusions: Decompressive craniectomy is safe and effective method that can be life saving in patients with malignant cereal infarction and decrease mortality rate, improve neurological and functional outcome and decrease the long–term disability in these patients