title: Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report.
abstract: BACKGROUND
  Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue.
  
  
  METHODS
  This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS), Barthel index (BI) and improvement in language and motor function were evaluated to determine functional outcome.
  
  
  RESULTS
  Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18), 64% (11/17), 62.5% (10/16) and 62.5% (10/16) respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8) or without (5/8) support. Age <50 years corresponded with better functional outcome amongst survivors (P value -0.0068).
  
  
  CONCLUSIONS
  Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years) with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with.
authors: Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Amandeep
authors: A
authors: Kumar
authors: Manish Singh
authors: MS
authors: Sharma
authors: Bhawani Shanker
authors: BS
authors: Sharma
authors: Rohit
authors: R
authors: Bhatia
authors: Manmohan
authors: M
authors: Singh
authors: Ajay
authors: A
authors: Garg
authors: Rajinder
authors: R
authors: Kumar
authors: Ashish
authors: A
authors: Suri
authors: Poodipedi Sarat
authors: PS
authors: Chandra
authors: Shashank Sharad
authors: SS
authors: Kale
authors: Ashok Kumar
authors: AK
authors: Mahapatra
keywords: Craniectomy; dominant; middle cerebral artery; outcome; stroke