| Background & Objective:Malignant middle cerebral artery (MCA) infarction is a kind of large hemispheric infarction with poor outcomes, and characterized by a high mortality rate of up to 80%. Decompressive craniectomy (DC) has been proved to be a positive and effective treatment; The aim of this study was to analyze the prognostic factors in patients with malignant middle cerebral artery infaction who underwent decompressive craniectomy.Data & methods:From January 2009 to July 2009,24 patients with malignant MCA infarction were included in the study. All the patients in the study underwent decompressive craniectomy. The infarction territory was evaluated by either diffusion-weighted MRI or computed tomography. Midline and septum pellucidum shift was measured, too. Based on their Glasgow Outcome Scales(GOS), which was calculated 6 months postoperatively, patients were divided into two functional groups: good (GOS 4-5) and poor (GOS 1-3). The characteristics of the two groups were compared by statistical analysis.Results:The mean age of all the 24 patients is 59.8±9.4years old, the mean time from fraction to operation is 52±23.7 hours; Mortality was 8.3%(2 patients) during 30 days and 20.8%(5 patients) during 6 months' follow-up. Age≤60 years (P=0.021), preoperative midline shift lesser than 11mm (P=0.008), early operation(P=0.035), without diabetes mellitus (P=0.036) were the positive predictors of a good outcome. Conclusion:Decompressive craniectomy for spaceoccupying large hemispheric infarction as a life-sparing procedure that sometimes yields good functional outcomes. A dominant hemispheric infarction should not be an exclusion criterion when deciding to perform this operation. Young patients, less midline shift and without base diseases can improve the functional outcome of surgical management for large hemispheric infarction. |
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