Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarct

Authors

  • Farooq Azam Department of Neurosurgery Lady Reading Hospital, Peshawar – Pakistan
  • AEEM-UL- HAQ Department of Neurosurgery, Lady Reading Hospital, Peshawar – Pakistan
  • MUHAMMAD USMAN Department of Neurosurgery, Lady Reading Hospital, Peshawar – Pakistan
  • Mohammad Ishaq Department of Neurosurgery, Lady Reading Hospital, Peshawar – Pakistan

Keywords:

Decompressive Hemicraniectomy, Middle Cerebral Artery,, Infarct, Outcome.

Abstract

Objective: To know outcome of Decompressive hemicraniectomy in patients presented with malignant middle cerebral artery (MCA) infarct.
Materials and Methods: This prospective study was conducted in Neurosurgery department of Lady Reading Hospital, from December 2011 toNovember 2014. A total number of 10 patients were included in the study. All patients were admitted in neurosurgery ward through emergency, were subjected to detail history and exami-nation. After preoperative workup patients were operated in emergency. We analyzed gender, age, Glasgow Coma Scale (GCS) on admission, pre-surgical evaluation, clinical status on pre-surgical exam, and Glasgow Outcome Scale (GOS), immediate postoperatively, at 3 months and 6 months after discharge. We assessed out-come by Glasgow outcome score and modified Rankin scale (mRS). Data was analyzed by SPSS version 17.
Results: Of the total 10 patients, 8 (80%) were male and 2 (20%) were female. Age ranged from 40 to 75 years (mean 62.7 ± 11.19 years). On admission, the mean GCS was 10 (Ranged from 8 to 12). Time between onset of symptoms and decompressive craniectomy was less than 24 hours in 2 (20%), 24-48 hours in 3 (30%), 48 – 72 hours in 1 (10%) and 72-96 hours in 4 cases (40%). Early surgery (? 48 hours) was carried out in 5 (50%) cases and late surgery (? 48 hours) in other 5 (50%) patients. Length of stay in the hospital was 7 to 16 (mean 11.5) days. Surgery improved significantly the GCS of patients comparing the immediate preoperative scores (6 to 10) and immediate post-operative GCS 5 to 15 (mean 10).
Conclusion: Decompressive hemicraniectomy increases the probability of survival without increasing the number of very severely disabled survivors. Still, the decision to perform surgery should be made on an individual basis in every patient.

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Published

2018-10-04

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Vol. 21 No. 2 (2017): April-June

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Original Articles

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