DOI: 10.14704/nq.2022.20.11.NQ66209

Decompressive Craniectomy in Malignant MCA Infarct - Functional Outcome and Mortality In 50 Cases

Rajeev Goel, Arvinpreet Kour, Ajaydeep Singh

Abstract

Introduction:Malignant MCA infarction is characterized by acute massive brain edema, elevated intracranial pressure, and uncal herniation. In spite of maximum medical therapy such as intracranial pressure lowering measures, hypothermia, and controlled hyperventilation, malignant MCA infarction could result in death in 70–80% of cases and most survivors are left with long-term disability. Several studies have suggested that decompressive surgery reduces mortality and improves functional outcome of these patients. Aim: To review our experience at tertiary care centre MMIMSR, Mullana with decompressive craniectomy in large hemispheric infarction with regard to the functional outcome and mortality. Material and Methods: It was a prospective study included 50 patients (for 2 years) with large MCA territory infarction who were operated at MMIMSR, Mullana. Functional outcome was assessed in terms of mortality and modified Rankin Scale (mRS) for neurologic disability. Result: Favourable functional outcome (mRS 0–3) noticed in 28% patients at 3 months which further improved to 42 % at 6 months follow up, while poor outcome (mRS 4–6) noticed in 72% at 3 months which decreased to 42 % at 6 months follow-up period. The overall mortality in this study was 16%. Conclusion: Decompressive craniectomy for malignant MCA infarction has an effective role in increasing the number of patients with a favourable outcome.

Keywords

Decompressive craniectomy, malignant MCA infarction, hemispheric infarction, hemiplegia, modified Rankin Scale

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