Prospective studies on decompressive craniotomy for malignant MCA infarctions in Brazil: ready for prime time

Cabral, Lucélia; Filho, Paulo Eloy Passos

doi:10.1590/0004-282x20170159

Cited by 1 publication

(1 citation statement)

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“…DC was shown to have important effects on mortality in the patients with malign MCA infarct especially if performed in the first 48 hours of the event (13)(14)(15). This method was shown to significantly reduce the mortality in these patients especially before neurological signs and symptoms were developed (16). However, in some studies showed nonsignificant benefit with DC in these patients (17).…”

Section: Introductionmentioning

confidence: 99%

What is the optimum time to decompressive surgery in the patients with malignant middle cerebral artery infarction?

Yücetaş¹,

Üçler²,

Kafadar³

et al. 2019

Ann Med Res

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In the patients with malignant middle cerebral artery (MCA) infarctions, the mortality was as high as 70% with conservative treatment. Decompressive craniectomy (DC) was shown to decrease mortality especially in 48 hours. We aimed to investigate both the effect of decompression time and the size of craniectomy on the mortality in this patient group. Material and Methods: 45 adult patients underwent to DC due to malignant MCA infarction were evaluated in this study. The demographic and clinical features were recorded retrospectively. The patients were splitted into three groups: Group 1, DC in the first 24 hours; group 2, in 24-48th hours; group3, in 48-96th hours of the admission. The size of craniectomy was the same as the infarct (standard), or it was two centimeters larger than the size of infarct (larger). Results: Of all patients, 53.3% (n=24) was female; and mean age of the sample was 67.38±4.76. 66.7% (n=30) of the patients died due to malign MCA infarction. The size of craniectomy was larger in 26.7% (n=12), and was standard in the others. Mean time to surgery was 43.07±29.87 hours. Mortality rate was minimum in group 2 (p=0.01). The patients undergoing to larger craniectomy survived longer than the others, but the difference was non-significant (p=0.06). Conclusion: We suggested that not the approach of "surgery as soon as possible" but the surgery between 24-48th hours of the admission would be the optimal approach. This issue is especially important, because earlier or later interventions not only have a less benefit on the outcome but also may lead several unnecessary complications.

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