Decompressive hemicraniectomy in malignant middle cerebral artery infarction: outcomes of 22 patients

Large middle cerebral artery (MCA) infarctions presenting as malignant cerebral edema account for 1-10% of all ischemic strokes. Mortality rates have been reported to be as high as 80%, and most of the survivors are left severely disabled. Decompressive hemicraniectomy (DHC) can reduce mortality and severe disability. The objective of this work is to help better define the selection criteria for performing the surgery in case of large MCA infarctions. From August 2000 to March 2014, 22 patients with malignant MCA infarction were included in the study. During that period, all the patients underwent DHC due to transtentorial herniation despite the appropriate medical treatment. The mean age of the patients was 63 years old. Among them, 9 patients (41%) were expired. The outcomes of patients with malignant MCA infarction who underwent DHC were compared with the previously published data. In the management of patients with acute ischemic stroke, it has become clear that in a number of these cases a progressive and often fatal deterioration secondary to mass effect from the edematous, infarcted tissue occurs. Some of these patients may benefit from undergoing a DHC but the timing and indications for this potential lifesaving procedure are still debated. DHC may be an useful procedure in patients with malignant MCA infarction. Timing of surgery and appropriate patient selection based on age and other criteria requires further investi-