title: Decompressive hemicraniectomy, strokectomy, or both in the treatment of malignant middle cerebral artery syndrome.
abstract: OBJECTIVE
  We sought to evaluate the impact of a craniotomy for strokectomy (CS) with bone replacement, decompressive hemicraniectomy (DHC), or DHC with a strokectomy (DHC+S) on outcome after malignant supratentorial infarction.
  
  
  METHODS
  We conducted a retrospective cohort study of cases of malignant supratentorial infarction treated by CS (n = 18), DHC (n = 17), or DHC+S (n = 33) at our institution from 2002 to 2008. End points included functional outcome measured by the modified Rankin Scale and incidence of mortality at 1 year.
  
  
  RESULTS
  Mean age, gender, side, vessel, and time from ictus to surgery were not statistically different between treatment groups. Stroke volume was significantly higher in the CS group. Operative time and blood loss were significantly higher in the DHC+S group. At 1 year, the median modified Rankin Scale score was 4 and overall survival was 71%. Functional outcomes and mortality for both the CS and DHC+S groups were not significantly different from the DHC group (P = 0.24). After adjusting for patient age, stroke volume, and time to surgery, there was no significant difference in outcome.
  
  
  CONCLUSIONS
  In patients with malignant supratentorial infarction, a strokectomy alone may be equivalent to a decompressive hemicraniectomy with or without brain resection.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Dean B
authors.initials: DB
authors.lastname: Kostov
authors.forename: Richard H
authors.initials: RH
authors.lastname: Singleton
authors.forename: David
authors.initials: D
authors.lastname: Panczykowski
authors.forename: Hilal A
authors.initials: HA
authors.lastname: Kanaan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.forename: Brian T
authors.initials: BT
authors.lastname: Jankowitz
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D002544:Cerebral Infarction / Q000401:mortality* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality* / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome