title: Functional Outcome After Decompressive Craniectomy in Patients with Dominant or Non-Dominant Malignant Middle Cerebral Infarcts.
abstract: BACKGROUND
  The use of decompressive craniectomy (DC) has been studied in the setting of different conditions, including traumatic brain injury, subarachnoid hemorrhage, and malignant middle cerebral artery (MCA) infarction. The rationale of this study is to determine the functional outcome after DC in patients with malignant MCA infarcts.
  
  
  METHODS
  A longitudinal cohort study was performed based on patients diagnosed with malignant MCA territory infarction admitted to the Neurosurgery Department of a tertiary care hospital in Islamabad, Pakistan between July 2015 and November 2016. All patients had a clinical diagnosis of stroke according to the World Health Organization (WHO) stroke criteria.
  
  
  RESULTS
  A total of 34 patients participated in this study, out of which 20/31 (64.5%) were males while 11/31 (35.5%) were females with a mean age of 51.61 ± 13.96 years. The mean time from diagnosis to surgery was 60.61 ± 49.83 hours. Out of 31 patients, 18 (58.1%) had a right middle cerebral artery infarct (RMCAI) and 13 (41.9%) had a left middle cerebral artery infarct (LCAI). Logistic regression was applied to assess the association between the type of MCA infarct with the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), modified Barthel Index (mBI) scores, and upper and lower limb motor power. However, the logistic regression model was not statistically significant χ2(4) = 3.896, p = 0.866. There was a statistically significant mild improvement of neurological scores and upper and lower motor power over a course of six months, but the overall functional outcome was poor with mBI < 60 and mRS > 4 (p < 0.001) with total mortality of 8.7%.
  
  
  CONCLUSIONS
  Decompressive craniectomy is a life-saving surgery that appears to benefit patients with malignant MCA infarcts of either the dominant or non-dominant cerebral hemisphere. Decompressive craniectomy results in mild improvements in neurological scores but still poor functional outcome after six months.
authors.affiliation: Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Kamal Alam
authors.affiliation: Research Associate, Department of Neurology, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Bukhari
authors.affiliation: Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
authors.forename: Salman
authors.initials: S
authors.lastname: Assad
authors.affiliation: Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Pir
authors.initials: P
authors.lastname: Muhammad Siddique
authors.affiliation: Department of Neurology, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Haider
authors.initials: H
authors.lastname: Ghazanfar
authors.affiliation: Department of Genito-urinary Oncology, Weill Medical College of Cornell University.
authors.forename: Muhammad Junaid
authors.initials: MJ
authors.lastname: Niaz
authors.affiliation: Department of Internal Medicine, Carthage Area Hospital, New York, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kundi
authors.affiliation: Department of General Medicine, Hayatabad Medical Complex, Peshawar, Pakistan.
authors.forename: Saima
authors.initials: S
authors.lastname: Shah
authors.affiliation: Consultant Neurologist, Department of Neurology, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Maimoona
authors.initials: M
authors.lastname: Siddiqui
keywords: decompressive craniectomy; functional outcome; ischemic stroke