10-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction (mMCAI)

Abstract A 10-year retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken (2005-2015). Patient demographics, co-morbidities, pre- and post-operative neurological state, operative timescales, craniectomy dimensions and Glasgow Outcome Scale (GOS) scores were analysed. Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% (n=7). 17 patients (42.5%) were male with a mean age of 43yrs (range: 16-64yrs). Patients who survived had a lower mean age of 41yrs (range: 16-59yrs) than those who did not of 50yrs (range: 42-63yrs). The modal ictal and preoperative GCS were 14 (range: 5–15) and 7 (range: 3–12) which corresponded to motor scores of 6 and 5 respectively. The mean time from ictus to INS admission was 23.5hrs (range: 0.5-66hrs) and from INS admission to decompression 7.5hrs (range: 0.5-46hrs). Approximately 60% of patients had an “early” craniectomy (under 48hrs from ictus) and 60% of patients had a craniectomy performed less than 24hrs from INS admission. The mean maximum antero-posterior (AP) craniectomy diameter measured 13cm (range: 10.93–15.12cm) and the mean surface area was 92.68 cm2 (range: 76.14–124.42cm2 ). Overall 80% of patients had a modal Glasgow Outcome Scale (GOS) score of 3 (range: 2-5) at discharge, 3-months, 6-months, 9-months and 12-months. The median length of stay was 3 days (range: 6hrs - 11 days) for non-survivors and 13 days (range: 1 - 365 days) for survivors. Decompressive craniectomy for mMCAI is suitable in selected patients and the local practice is consistent with current evidence1.