IP Indian Journal of Neurosciences


Role of early decompressive hemicraniectomy (<24 hours) in malignant middle cerebral artery infarct


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Author Details: Dipesh Batra,Hanish Bansal*,Ashwani Kumar Chaudhary,Rakesh Kaushal

Volume : 5

Issue : 1

Online ISSN : 2581-916X

Print ISSN : 2581-8236

Article First Page : 12

Article End Page : 16


Abstract

Introduction: Malignant middle cerebral artery territory infarct carries a mortality rate as high as 80% and produces severe disability among survivors. Decompressive hemicraniectomy is a lifesaving surgical procedure to decrease the intracranial mass effect and reduces the risk of transtentorial herniation but there are concerns that it also creates large number of survivors with severe neurological deficit.
Materials and Methods: All patients with malignant middle cerebral artery infarction fulfilling the inclusion criteria underwent surgical intervention in form of decompressive hemicraniectomy. The patients were divided into two groups: Group A (operated within 24 hours) and Group B (operated after 24 hours of stroke). The outcome of the patients was evaluated according to mRS and Barthel index.
Results: Mean mRS at discharge in patients operated within 24 hours was 4.31±0.75 whereas it was 4.54±0.52 in patients operated outside 24 hours but the difference was not significant statistically. At 3 months after discharge, mean mRS was 3.08±0.86 in Group A whereas it was 3.77±0.73 in Group B which was found to be statistically significant (p= 0.001).
Conclusion: Our study concluded that after decompressive craniectomy probability of survival significantly increased and patient with favourable outcome, mRS?3 increases. Early decompressive craniectomy reduced mortality rates, patient had better outcome and early recovery.

Keywords: Decompressive hemicraniectomy, Malignant infarct, Herniation, Modified rankin scale, Middle cerebral artery.