Prognostic Markers and Outcome of Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

Objective: To determine the survival rate and functional outcome along with the associated factors in the post Decompressive hemicraniectomy patients with malignant middle cerebral artery infarction. Background: Decompressive hemicraniectomy(DH) is done as an emergency surgical procedure for malignant middle cerebral artery(MCA) infarction. Though DH has shown decreased mortality, the functional outcome and prognostic markers are still inconclusive. Design/Methods: This was a prospective study from November 2015 to June 2017 at tertiary care hospital, Chennai (Madras medical college-Government institution). Totally 37 patients with malignant MCA infarction underwent DH were included in this study. All the patients were analyzed for preoperative clinical condition, Glascow coma scale, cause of infarction and timing of surgery. The location of infarction and its extension was evaluated by CT brain or MRI brain. The functional outcome was assessed with Barthel index (BI) and modified Rankin scale(mRS) during the follow up period of 6 months. Results: Totally sixteen (43.2%) patients had favorable outcome (BI≥60). The factors associated with favorable outcome were age Conclusions: Decompressive hemicraniectomy can be considered as a useful surgical treatment in malignant MCA infarction. Age less than 60 years, right hemisphere involvement, surgery within 24 hours of ictus before clinical signs of herniation and regaining of consciousness within 5 days of surgery were considered as good prognostic factors associated with better functional outcome. Disclosure: Dr. Gowthaman has nothing to disclose. Dr. Samivel has nothing to disclose. Dr. Natesan has nothing to disclose. Dr. Janarthnam has nothing to disclose. Dr. Ranganathan has nothing to disclose.