Early versus late surgical decompression in patients with malignant middle cerebral artery infarction

Abstract

Objective: Malignant cerebral edema accompanying ischemic stroke is life threatening. Decompressive hemicraniectomy (DHC) has been suggested as an alternative or adjunct therapeutic strategy for cerebral edema in order to decrease mortality and enhance functional outcomes because medical treatment alone is mostly insufficient. The aim of this study was to determine the efficacy of early DHC in patients with malignant middle cerebral artery (MCA) infarction. Methods: A retrospective, single-center, cohort study was conducted on a consecutive sample of 96 patients who underwent DHC due to MCA infarction. We assessed the influence of early DHC (<24 hours after the onset of symptoms) versus late DHC (>24 hours after the first signs of herniation) on mortality and functional outcome. Outcomes were evaluated in terms of 1-month mortality and the modified Rankin Scale (mRS) score (with favorable outcome defined as mRS ≤3) at the 3rd month follow-up. Results: The age of the patients ranged from 18 to 80 years, with a mean age of 53.98±12.01 years and 58.87±11.6 years in the early and late-DHC groups, respectively. The 1-month mortality rate was 20.3% in the early-DHC group and 50% in the late-DHC group (p=0.006). The mortality rate was significantly higher in the late-DHC group. At the 3rd month follow-up, the percentage of patients with an mRS≤3 was 31.3% in the early-DHC group and 9.4% in the late-DHC group (p=0.035). The difference was statistically significant. Conclusion: This study demonstrated that early-DHC may decrease mortality and improve functional outcomes in patients with malignant MCA infarction.