title: Predictive factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction.
abstract: BACKGROUND
  The mortality rate of patients with brain oedema after malignant middle cerebral artery (MCA) infarction approaches 80 % without surgical intervention. Surgical treatment with ipsilateral decompressive hemicraniectomy (DHC) has been shown to dramatically improve survival rates. DHC currently lacks established inclusion criteria and additional research is needed to assess the impact of prognostic factors on functional outcome. The aim of this study was to assess the impact of prognostic factors on functional outcome.
  
  
  METHODS
  A retrospective cohort study was carried out including 46 patients who underwent DHC at the Karolinska University Hospital between 2004 and 2014. The maximum time to surgery was 5 days after symptom debut. The primary endpoint was a dichotomised score on the modified Rankin Scale (mRS) 3 months after surgery, with favourable outcome defined as mRS ≤ 4.
  
  
  RESULTS
  When the study population was dichotomised according to the primary endpoint, a significant difference between the groups was seen in preoperative Glasgow Coma Score (GCS), blood glucose levels and the infarction's involvement of the basal ganglia (p < 0.05). In a logistic regression model, preoperative GCS contributed significantly with a 59.6 % increase in the probability of favourable outcome for each point gained in preoperative GCS (p = 0.035).
  
  
  CONCLUSIONS
  The results indicate that preoperative GCS, blood glucose and the infarction's involvement of the basal ganglia are strong predictors of clinical outcome. These factors should be considered when assessing the probable outcome of DHC, and additional research based on these factors may contribute to improved inclusion criteria for DHC.
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Oliver
authors.initials: O
authors.lastname: von Olnhausen
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Thorén
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: von Vogelsang
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Svensson
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. gaston.schechtmann@karolinska.se.|Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. gaston.schechtmann@karolinska.se.
authors.forename: Gastón
authors.initials: G
authors.lastname: Schechtmann
mesh_terms: D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000401:mortality / Q000601:surgery; D003399:Craniotomy / Q000379:methods* / Q000401:mortality; D019299:Decompression, Surgical / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Craniotomy; Infarction; Middle cerebral artery; Stroke; Surgical; Treatment outcome