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.

Keywords

• decompressive craniotomy
• stroke
• malign middle cerebral artery infarction

Malign Orta Serebral Arter Enfarktüsü İçin Dekompresif Kraniyotomi: Prospektif Bir Kohort Çalışması

Abstract

Amaç: Malign orta serebral arter (Middle Cerebral Artery- MCA) infarktları için ölüm oranı çok yüksektir. Dekompresif kraniyotomi (DK) mortaliteyi azaltıyor gibi görünse de yaşam kalitesi halen güncel bir tartışma konusudur. Yüksek hacimli üçüncü basamak hastanemizde medikal veya cerrahi olarak tedavi edilen malign MCA enfarktüslü hastaların sonuçlarını sunmayı amaçladık. Araçlar ve Yöntem: Çalışma prospektif kohort olarak tasarlanmıştır. Kriterleri karşılayan her hastaya DK önerildi, kabul etmeyenler kontrol medikal tedavi grubu olarak takibe alındı. Hastalar ameliyat öncesi, ameliyat sonrası erken dönem ve 1./3./6./12. aylarda değerlendirilmiştir. Bulgular: Kırk iki hasta çalışmaya dahil edildi (17/ameliyat, 25/medikal). Her takip döneminde DK hastalarının hayatta kalma oranları, sadece tıbbi tedavi alanlardan daha yüksekti. Bu fark postoperatif 1., 3. ve 6. aylarda da anlamlıydı. Ek olarak, modifiye Rankin Ölçeği incelemesi, DK'nin her kontrol periyodunda üstün olduğunu göstermiştir. Sonuç: Çalışmamızda DK uygulanan hastaların mortalitesinin (sadece medical tedavi uygulananlara göre daha düşük olsa da) diğer serilere göre daha yüksek olması, ameliyat sırasındaki nörolojik durumun kötü olması ile açıklanabilir. Ameliyat endikasyonu için hastanın durumunun çok kötüleşmesi beklenmemelidir. Bu amaçla hastaların nörolojik durumundaki kötüleşmenin erken dönemde sık muayene ile beyin cerrahına bildirilmesi gerekmektedir. Nörolojik durumunda kötüleşme olasılığı olan hastaların beyin cerrahisi kliniğine sevk edilmesi alternatif bir çözüm olabilir.

Keywords

• dekompresif kraniyotomi
• inme
• malign orta serebral arter enfarktüsü

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