Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction.
BACKGROUND
Malignant cerebral infarction is a well-recognized disease, comprising 10-15% of all cases with cerebral infarction and causing herniation and death in 80% of cases. In this study, we compare the effects of decompressive craniectomy versus conventional medical treatment on mortality rate and functional and neurological outcome in patients with malignant MCA infarction.


METHODS
We performed a prospective case-control study on 60 patients younger than 80years of age suffering malignant MCA cerebral infarction. The case group underwent decompressive craniectomy in addition to routine aggressive medical care; while the control group received routine medical treatment. Patient outcome was assessed using Glasgow outcome scale and modified Rankin scale within three months of follow-up. The data were analyzed by SPSS version 16.0 software using Chi Square, One-way ANOVA and Mann-Whitney tests.


RESULTS
There were 27 male and 33 female patients with a mean age of 60.6 years (SD = 12.3). Glasgow outcome scale score averaged 2.93 in the surgical versus 1.53 in the medical group; this difference was significant (p = 0.001). Outcome in modified Rankin scale was also significantly lower in the surgical (3.27) versus medical (5.27) group (p < 0.001). Surgery could decrease the mortality rate about 47%.


CONCLUSIONS
In this study, decompressive craniectomy could decrease mortality rate, and improve neurological and functional outcome, and decrease long-term disability in patients with malignant MCA infarction.
Department of Neurosurgery, Shiraz University of Medical Sciences, Nemazee Hospital, P.O. Box: 71937-11351, Shiraz, Iran.
Abdolkarim
A
Rahmanian
Department of Neurosurgery, Shiraz University of Medical Sciences, Nemazee Hospital, P.O. Box: 71937-11351, Shiraz, Iran.
Babak
B
Seifzadeh
Department of Neurosurgery, Shiraz University of Medical Sciences, Nemazee Hospital, P.O. Box: 71937-11351, Shiraz, Iran ; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Ali
A
Razmkon
Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
Peyman
P
Petramfar
Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
Juri
J
Kivelev
Department of Neurosurgery, Shiraz University of Medical Sciences, Nemazee Hospital, P.O. Box: 71937-11351, Shiraz, Iran.
Ehsan-Ali
EA
Alibai
Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
Juha
J
Hernesniemi
Cerebral infarction; Decompressive craniectomy; Middle cerebral artery