The Outcome Following Decompressive Craniectomy or Conservative Treatment for Malignant Middle Cerebral Artery Infarction

Authors

  • Nanthasiri Wittayanakorn Division of Neurosurgery, Department of Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand
  • Sutthikorn Tantbirojn Division of Neurosurgery, Department of Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand

Keywords:

malignant MCA infarction, decompressive craniectomy, decompressive surgery in elderly

Abstract

Background: At present, malignant middle cerebral artery (MCA) infarction has a high morbidity and
mortality rate worldwide. The aims of this study were to identify the mortality rate, to determine the value of
decompressive craniectomy in patients who were presented with malignant middle cerebral artery (MCA)
infarction, to compare functional outcome in elderly patients with younger patients and identify significant risk
factors related to the mortality.
Method: Medical records of patients with malignant middle cerebral artery (MCA) infarction treated in
Bhumibol Adulyadej Hospital between January 2008 and April 2011 were reviewed. A total of 82 patients with
complete medical records and radiographic imagines were included in this study. The area of infarction was
determined by the ABC/2 method and the degree of herniation was determined with Ambient cistern
effacement and shift of the midline. The Glasgow Coma Scale score was assessed for neurologic status at
admission, at operative time (in surgery group), and at one-week time after infarction. All patients were assessed
with the modified Rankin Scale (RS) at discharge and at 3 months after infarction.
Results: The mortality rate of patients with malignant middle cerebral artery (MCA) infarction at
discharge was 45% and 3 months after infarction was 48.8%. At discharge, there was a significant difference in
the mortality of patients with malignant middle cerebral artery (MCA) infarction in conservative group and
surgery group [(17/50 (34%) versus 20/32 (62.5%)), p = 0 .011]. Also at 3 months after infarction, there was a
significant difference in mortality in the conservative group and the surgery group [(19/50 (38.0%) versus 21/
32 (65.6%)), p = 0.015]. There was a significant high mortality rate in the surgery group with age≤ 60 years.
Dyslipidemia and ischemic heart disease were risk factors of malignant middle cerebral artery (MCA infarction
related death with an odd ratio 1.419 (95%CI 0.504-4.00) and 2.00 (95%CI 0.345-11.578) respectively.
Conclusion: The mortality rate of patients with malignant middle cerebral artery (MCA) infraction treated
at our hospital was nearly 50% and the rest of the patients were dependent. There was a significant high
mortality rate in the surgery group with age≤ 60 years which could be explained by the severity of thedisease.
In addition, the more underlying diseases, the higher the mortality rate will be.

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65

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Published

2012-06-29

How to Cite

1.
Wittayanakorn N, Tantbirojn S. The Outcome Following Decompressive Craniectomy or Conservative Treatment for Malignant Middle Cerebral Artery Infarction. Thai J Surg [Internet]. 2012 Jun. 29 [cited 2024 Mar. 29];33(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226865

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