title: Postoperative midline shift as secondary screening for the long-term outcomes of surgical decompression of malignant middle cerebral artery infarcts.
abstract: Decompressive hemicraniectomy (DC) can save the lives of patients with malignant middle cerebral artery (MCA) infarction. We proposed that postoperative midline shift is important for the long-term outcome of patients with MCA infarction. We conducted a retrospective study of DC in 38 patients with malignant MCA infarction. The long-term outcome was assessed one year after surgery using the modified Rankin Scale (mRS) score. Patients who had midline shift less than the optimal diagnostic cut-off point on the fourth postoperative day were classified as having a successful decompression and the remaining patients were classified in the failed decompression group. The successful decompression group mRS score was 4.20±0.89 one year after surgery and the failed decompression group mRS score was 5.11±0.76 (p<0.0001). Successful decompression, resulting in postoperative midline shift of less than 5mm, was a key factor for beneficial, long-term functional outcomes in patients with malignant MCA infarction.
authors.affiliation: Department of Neurosurgery, Chang Gung University, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Tu
authors.forename: Zhuo-Hao
authors.initials: ZH
authors.lastname: Liu
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Chuang
authors.forename: Tao-Chieh
authors.initials: TC
authors.lastname: Yang
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D013995:Time; D016896:Treatment Outcome