title: Preliminary results of randomized controlled study on decompressive craniectomy in treatment of malignant middle cerebral artery stroke.
abstract: OBJECTIVE
  Studies on decompressive craniectomy (DCE) after a malignant middle cerebral artery (MCA) stroke in selected population show an increased probability of survival without increasing the number of very severely disabled. Cerebral infarct volume (CIV) as a triage criterion for performing surgery has not been discussed in literature. The aim of this study was to investigate the value of CIV and initial National Institutes of Health Stroke Scale (NIHHS) and Glasgow Coma Scale (GCS) scores as possible triage criteria in the surgical treatment of patients with "malignant" MCA stroke.
  
  
  METHODS
  According to the study protocol, 28 patients with a malignant MCA stroke were included and analyzed prospectively. The patients were randomly divided either into the DCE plus best medical treatment (BMT) group or BMT alone group. CIV and NIHHS and GCS scores were measured at time of enrollment in every case. Clinical outcome was evaluated 1 year after the treatment.
  
  
  RESULTS
  Six patients survived: 5 in the DCE group (none of them was older than 60 years) and 1 in the BMT group (P=0.03/0.06). Among survivors, none had a cerebral infarct volume of more than 390 cm(3) (P=0.05). All survivors in the DCE group had favorable outcomes. There was no significant difference in the NIHSS and GCS scores between the groups and survivors/nonsurvivors (P>0.05).
  
  
  CONCLUSIONS
  Decompressive surgery in the selected patients is likely to increase the probability of survival with a favorable outcome without increasing the number of severely disabled survivors. Patients with CIV of more than 390 cm(3) may be bad candidates for DCE, and the prognosis is likely to be bad regardless the treatment strategy. The initial NIHHS and GCS scores did not prove any prognostic value in outcome.
authors: Neurosurgery Clinic, Pauls Stradins Clinical University Hospital, Latvia. janis.slezins@inbox.lv
authors: Janis
authors: J
authors: Slezins
authors: Valdis
authors: V
authors: Keris
authors: Raimonds
authors: R
authors: Bricis
authors: Andrejs
authors: A
authors: Millers
authors: Egils
authors: E
authors: Valeinis
authors: Janis
authors: J
authors: Stukens
authors: Olga
authors: O
authors: Minibajeva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D056424:Decompressive Craniectomy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome