title: Decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Malignant middle cerebral artery infarctions (mMCAI) are one of the most devastating ischemic strokes, with up to 80% mortality in non-surgically treated patients. With the publication of three European randomized controlled trials (RCTs), decompressive hemicraniectomy (DHC) was recommended in patients with mMCAI who are aged ≤ 60 years. Recently, three other RCTs enrolling patients aged > 60 years were published; thus, it is necessary to update the previous meta-analysis to re-evaluate the effects of DHC in mMCAI.
  
  
  METHODS
  A systematic literature search of PubMed, EMBASE, and the Cochrane Library was conducted for published RCTs investigating the effects of DHC in mMCAI. Primary outcomes were mortality and major disability (modified Rankin Scale score: 4-5) among survivors. Secondary outcomes were death or major disability (mRS score > 3), and death or severe disability (mRS score > 4). Effect sizes were expressed in Peto odds ratio (Peto OR) with 95% confidence intervals.
  
  
  RESULTS
  Six studies with 314 patients were subjected to meta-analysis. Data showed that DHC, significantly decreased mortality risk, death or major disability (mRS score > 3), and death or severe disability (mRS score > 4); but was associated with a slightly higher proportion of major disability (mRS score: 4-5) among survivors. There were no statistically significant age differences.
  
  
  CONCLUSIONS
  Compared to conservative treatment, DHC significantly decreased mortality and improved functional outcome, with a non-significant increase in the proportion of survivors with major disability. Further studies are required for multidimensional evaluation of DHC for mMCAI.
authors: Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China. Electronic address: minghao.yang@outlook.com.
authors: Ming-Hao
authors: MH
authors: Yang
authors: Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China. Electronic address: linhongyu1987@sina.com.
authors: Hong-Yu
authors: HY
authors: Lin
authors: Department of Histology and Embryology, School of Pre-clinical Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors: Jun
authors: J
authors: Fu
authors: Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors: Gopaul
authors: G
authors: Roodrajeetsing
authors: Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors: Sheng-Liang
authors: SL
authors: Shi
authors: Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China. Electronic address: neurosurgui@vip.163.com.
authors: Shao-Wen
authors: SW
authors: Xiao
mesh_terms: D001929:Brain Edema / Q000209:etiology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery*; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: Decompressive hemicraniectomy; Infarction; Meta-analysis; Middle cerebral artery