Highlights
- •Decompressive hemicraniectomy is a lifesaving therapy for mMCA in the real world
- •Selected patients with malignant MCA may benefit from decompressive hemicraniectomy.
- •Cost-utility and perioperative complications should be considered for DHC
- •Patients and families should be correctly counseled about DHC
Abstract
Background
Malignant middle cerebral artery infarction (mMCA) is a devastating disease with rates
of fatality as high as 80%. Decompressive hemicraniectomy (DHC) reduces mortality,
but many survivors inevitably remain severely disabled.
This study aimed to analyze patients with mMCA undergoing DHC or best medical treatment
(BMT) baseline characteristics and factors linked to therapeutic choice and determinants
of prognosis.
Methods
We recorded clinical and radiological features of patients undergoing BMT or DHC.
The two groups were compared for epidemiology, clinical presentation, neuroimaging,
and prognosis. Regression analysis was performed to identify predictors of surgical
treatment and outcome.
Results
One hundred twenty-five patients were included (age 67.41 ± 1.39 yo; 65 M). Patients
undergoing DHC (N = 57) were younger (DHC 55.71 ± 1.48 yo vs. BMT 77.22 ± 1.38) and had midline shift (DHC 96.5% (55/57) vs. BMT 35.3% (24/68), a larger volume of the affected hemisphere and reduced ventricles volume as compared
to BMT.
The chance of surgery depended on age (Exp(B) = 0.871, p < 0.001), clinical status at onset (NIHSS Exp(B) = 0.824, p = 0.030) and volume of the ventricle of the affected hemisphere (Exp(B) = 0.736, p = 0.006).
Death rate during admission was significantly lower for DHC (DHC 15% (6/41) vs BMT 71.7% (38/53), Fisher's test = 30.234, p < 0.001).
Conclusion
Although DHC may cause prolonged hospitalization and long-term disabled patients,
it is a lifesaving therapy that should be considered for selected patients with mMCA
but perioperative complications and cost-utility should be considered. Patients and
families should be correctly counseled about this therapeutic choice and its short-
and long-term consequences.
Keywords
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Article info
Publication history
Published online: August 03, 2022
Accepted:
July 31,
2022
Received in revised form:
July 3,
2022
Received:
April 29,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
