Functional outcome and mortality prediction after decompressive craniectomy in patients with malignant middle cerebral artery infarction

Background Although it is well known that performing decompressive craniectomy (DC) in cases of swollen middle cerebral artery infarction (SMCAI) improves patient outcomes, limited evidence presently exists on the likelihood of mortality and achieving functional outcome following DC. The aim of the present study was to identify the predictors of early in-hospital mortality and functional status six months after performing DC in a cohort of patients with SMCAI. Material and methods All patients that had suffered SMCAI and underwent DC were included in the study sample and their demographic information, along with clinical and radiological findings, and risk factors were recorded for further analyses, which were conducted using the commercial software STATA. Modified Rankin Scale score (mRS) served as an outcome measure at 6-month follow-up. Results DC was performed on 50 patients with SMCAI (72% of whom had left hemisphere infractions) aged 45.2 ± 10.2 years (range 24–67 years), 32 (64%) of whom were female and 18 (36%) were male. While the initial median Glasgow Coma Scale (GCS) score was 8 (range 4–13), clinical deterioration mostly occurred within the first five days, whereby DC was performed within 9 ± 7.2 h (range 2–36 h). Following surgery, 16 (32%) patients died while in hospital, whereas the remaining 34 were discharged after 135 days on average, and attended the 6-month follow-up, when the median mRS score of 3 (range 2–6) was recorded for this subsample. Conclusions Younger age, higher GCS score, presence of isochoric pupils, history of prior treatment (e.g., embolectomy or tissue plasminogen activator), and shorter interval between clinical deterioration and surgery are associated with a lower likelihood of mortality and a greater odd of a favorable functional outcome.