Decompressive Craniectomy in patients with unilateral middle cerebral artery infarction; When to decompress and when to abort?

Document Type : Original Article

Authors

1 Neurosurgery,Faculty of medicine Banaha University- Banha

2 (1) Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt. (2) Department of Neurosurgery, der Barmherzigen Brüder Hospital Trier, Germany.

3 Neurosurgery Department , Benha Faculty of Medicine, Benha University ,Egypt

Abstract

Abstract
Background: The skull is a non-expandable structure like a ‘closed box’ holding constant contents of blood, water, and precious brain tissue. Decompressive Craniectomy (DC) is a short simple life-saving procedure directed to open the “closed box” in patients with refractory intracranial hypertension. Whether to do it or not, is a matter of argument as making the right decision is a very difficult process.
This study aims to present how we selected the patients for such procedure based on our institution experience.
Methods: 75 patients with unilateral Middle Cerebral Artery (MCA) infarction who underwent decompressive craniectomy between 2014 and 2019 at Banha University were analyzed prospectively. The decision of surgery was discussed with the family based on the clinical and radiological basis. The modified Rankin Scale (mRS) was used to evaluate the clinical outcome.
Results: A 12-month follow-up revealed; that 30 patients had a mild disability or good outcome, 35 patients were vegetative or severely disabled, and 10 patients had died. Favorable prognostic factors were younger age and preoperative GCS score (9 or higher).
Keywords: Decompressive craniectomy, Malignant infarction, Traumatic brain injury.
Corresponding author: Mohammed Mourad, Department of Neurosurgery, Benha University; Egypt. Tel: (+2)01558445071. email: morademan@yahoo.de.

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Zagazig University Medical Journal
Volume 30, Issue 1.2
January and February 2024
Pages 327-335

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