Early Versus Late Surgical Decompression Treatment In Patients With Malignant MCA Infarction
Yılmaz Dilek1, Eryıldız Ezgi Sezer2, Özkara Emre3, Özbek Zühtü3, Özdemir Atilla Özcan2
1Konya Numune State Hospital, Neurology, Konya
2Eskisehir Osmangazi University, Neurology, Eskişehir
3Eskisehir Osmangazi University, Neurosurgery, Eskişehir

Background: Malignant cerebral edema accompanying ischemic stroke is life threatening. Because medical treatment alone is mostly insufficient, 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. 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 symptom onset) versus late-DHC (>24 hours after the first signs of herniation) on mortality and functional outcome. The outcome was evaluated in terms of 1-month mortality and the modified Rankin Scale (mRS) score (with favorable outcome defined as mRS?3) at 3-month follow-up.. Results: The age of the patients ranged from 18 to 80, 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 rates were statistically significantly higher in the late-DHC group. The percentage of patients with an mRS?3 at the 3-month follow-up was 31.3% in the early-DHC group and 9.4% in the late-DHC group (p=0035). The difference was statistically significant. Conclusion: This study demonstrated that early-DCH may reduce mortality and improve functional outcome in patients with malignant MCA infarction.

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