title: 10-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction (mMCAI).
abstract: BACKGROUND
  A 10-year (2005-2015) retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken.
  
  
  METHODS
  Patient demographics, comorbidities, pre- and postoperative neurologic state, operative timescales, craniectomy dimensions, and Glasgow Outcome Scale scores were analyzed.
  
  
  RESULTS
  Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% (n = 7). Seventeen patients (42.5%) were male, with a mean age of 43 years (range: 16-64 years). Patients who survived had a lower mean age of 41 years (range: 16-59 years) than those who did not of 50 years (range: 42-63 years). The modal ictal and preoperative Glasgow Coma Scale scores were 14 (range: 5-15) and 7 (range: 3-12), which corresponded to motor scores of 6 and 5, respectively. The mean time from ictus to admission to the Institute of Neurological Sciences (INS) was 23.5 hours (range: 0.5-66 hours) and from INS admission to decompression 7.5 hours (range: 0.5-46 hours). Approximately 60% of patients had an "early" craniectomy (under 48 hours from ictus) and 60% of patients had a craniectomy performed less than 24 hours from INS admission. The mean maximum anteroposterior craniectomy diameter measured 13 cm (range: 10.93-15.12 cm) and the mean surface area was 92.68 cm2(range: 76.14-124.42 cm2). Overall 80% of patients had a modal Glasgow Outcome Scale score of 3 (range: 2-5) at discharge, 3 months, 6 months, 9 months, and 12 months. The median length of stay was 3 days (range: 6 hours to 11 days) for nonsurvivors and 13 days (range: 1-365 days) for survivors.
  
  
  CONCLUSIONS
  Decompressive craniectomy for mMCAI is suitable in selected patients, and the local practice is consistent with current evidence.
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, United Kingdom. Electronic address: lammy@doctors.org.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Lammy
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, United Kingdom.
authors.forename: Basel
authors.initials: B
authors.lastname: Al-Romhain
authors.affiliation: Department of General Medicine, Forth Valley Royal Hospital, Larbert, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Osborne
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, United Kingdom.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: St George
mesh_terms: D000293:Adolescent; D000328:Adult; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Craniectomy; Decompressive; Glasgow Outcome Scale Score; Malignant; Mortality