title: Decompressive craniectomy in malignant middle cerebral artery infarct: An institutional experience.
abstract: BACKGROUND
  Decompressive craniectomy as a surgical treatment for brain edema has been performed for many years and for several different pathophysiologies, including malignant middle cerebral artery (MCA) infarct. The purpose of this article was to share author's experience with decompressive craniectomy in malignant MCA infarct with special emphasis on patients older than 60 years and those operated outside 48 h after onset of stroke.
  
  
  METHODS
  Totally, 53 patients who underwent decompressive craniectomy after malignant MCA infarction between January 2012 and May 2014 at tertiary care hospital were analyzed for preoperative clinical condition, timing of surgery, cause of infarction, and location and extension of infarction. The outcome was assessed in terms of mortality and scores like modified Rankin scale (mRS).
  
  
  RESULTS
  Totally, 53 patients aged between 22 and 80 years (mean age was 54.92 ± 11.8 years) were analyzed in this study. Approximately, 60% patients were older than 60 years. Approximately, 74% patients operated within 48 h (25 patients) had mRS 0-3 at discharge while 56% patients operated after 48 h had mRS 0-3 at discharge which is not significant statistically. 78% patients aged below 60 years had mRS 0-3 at discharge while only 38% patients aged above 60 years had mRS 0-3 at discharge which was statistically significant (P < 0.008).
  
  
  CONCLUSIONS
  Decompressive craniectomy has reduced morbidity and mortality especially in people aged below 60 years and those operated within 48 h of malignant MCA stroke though those operated outside 48 h of stroke also fare well neurologically, there is no reason these patients should be denied surgery.
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Hanish
authors.initials: H
authors.lastname: Bansal
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Chaudhary
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Apinderpreet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Birinder
authors.initials: B
authors.lastname: Paul
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Rajveer
authors.initials: R
authors.lastname: Garg
keywords: Decompressive craniectomy; intracranial pressure; malignant middle cerebral artery infarct