title: Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  The aims of this study were to evaluate decompressive hemicraniectomy (DHC) versus conventional treatment (CT) for patients with malignant middle cerebral artery (MCA) infarction and to investigate the impact of age and surgical timing on neurologic function and mortality.
  
  
  METHODS
  We searched English and Chinese databases for randomized controlled trials or observational studies published before August 2016. Outcomes included good functional outcome (GFO), mortality, and National Institutes of Health Stroke Scale and Barthel index scores.
  
  
  RESULTS
  This meta-analysis included 25 studies (1727 patients). There were statistically significant differences between DHC and CT groups in terms of GFO (P < 0.0001), mortality (P < 0.00001), and National Institutes of Health Stroke Scale and Barthel index scores (P < 0.0001) at different follow-up points. Significant differences were observed between the groups in survival with moderately severe disability (P < 0.00001); no differences were observed in survival with severe disability. In the subgroup analysis, in the DHC group, GFO was less in patients >60 years old (9.65%) versus ≤60 years old (38.94%); more patients >60 years old had moderately severe or severe disability (55.27%) compared with patients ≤60 years old (44.21%).
  
  
  CONCLUSIONS
  DHC could significantly improve GFO and reduces mortality of patients of all ages with malignant MCA infarction compared with CT, without increasing the number of patients surviving with severe disability. However, patients in the DHC group more frequently had moderately severe disability. Patients >60 years old with malignant MCA infarction had a higher risk of surviving with moderately severe or severe disability and less GFO.
authors.affiliation: Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China; Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Li
authors.affiliation: Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany.
authors.forename: Meng-Zhuo
authors.initials: MZ
authors.lastname: Hou
authors.affiliation: Department of Preventive Medicine, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China; Disease Control in Disadvantaged Population Group, Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Lu
authors.affiliation: Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Ciccone
authors.affiliation: Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China.
authors.forename: Xing-Dong
authors.initials: XD
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China.
authors.forename: Lun
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China. Electronic address: zhanghengzhu@sina.com.
authors.forename: Heng-Zhu
authors.initials: HZ
authors.lastname: Zhang
mesh_terms: D000367:Age Factors; D056424:Decompressive Craniectomy; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000601:surgery*; D009026:Mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Decompressive surgery; Functional outcomes; Hemicraniectomy; Infarction; Meta-analysis; Stroke