title: National Survey of Neurosurgeons and Stroke Physicians on Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction.
abstract: BACKGROUND
  Several studies have evaluated the use of decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMCAI). In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has set criteria for selection of patients for DHC in MMCAI. We set out to survey the attitudes and practice of neurosurgeons and stroke physicians within the United Kingdom towards DHC in MMCAI.
  
  
  METHODS
  An electronic survey of questions on management of MMCAI in various clinical scenarios was submitted to the academic committees of the Society of British Neurological Surgeons and the British Association of Stroke Physicians for approval before dissemination through the consultant members. Responses were collected over 2 months.
  
  
  RESULTS
  A total of 78 responses, from 51 neurosurgeons and 27 stroke physicians, were included in final analysis. A total of 54% and 24% of all respondents would recommend DHC in patients aged 60-70 and 70-80 years, respectively; 60% would advocate surgery between 48 and 72 hours and 27% beyond 72 hours. A total of 36% indicated DHC with preoperative Glasgow Coma Scale 15/15. These findings do not conform to current NICE guidelines. Stroke physicians were statistically more likely to recommend DHC in patients older than 60 years (P = 0.032) and in those with dominant multiterritorial infarcts (P = 0.042) and accept a greater postoperative modified Rankin Scale (P = 0.034) compared with neurosurgeons.
  
  
  CONCLUSIONS
  In view of evidence from recent trials and differences in NICE guidelines and current clinical practice within the United Kingdom, based on our survey results, it is important to reevaluate NICE guidelines.
authors.affiliation: Department of Neuroscience, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Basu
authors.affiliation: Department of Neuroscience, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
authors.forename: Harri
authors.initials: H
authors.lastname: Jenkins
authors.affiliation: Department of Neuroscience, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
authors.forename: Kevin
authors.initials: K
authors.lastname: Tsang
authors.affiliation: Department of Neuroscience, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom. Electronic address: v.n.vakharia@doctors.org.uk.
authors.forename: Vejay N
authors.initials: VN
authors.lastname: Vakharia
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D015600:Glasgow Coma Scale; D006306:Health Surveys; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D020521:Stroke / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Decompressive hemicraniectomy; Malignant middle cerebral artery infarction; NICE guidelines; National survey; Neurosurgeons; Stroke physicians