INTRODUCTION. Malignant middle cerebral artery (MCA) infarction occurs in about 13 percent of all strokes with a mortality rate of as high as 80 percent. Hemicraniectomy for this condition has been reported to result in improvement of patients survival and long-term functional outcome. However, in our local setting, the role of hemicraniectomy is yet to be defined.
OBJECTIVE. We examined the role of hemicraniectomy for malignant MCA infarction by reviewing the mortality and long term functional outcome in this group of patients
METHODS. From the Stroke Data Bank registry, we reviewed the data of all patients who underwent decompressive surgery for malignant MCA infarction admitted from January 1, 1999 to January 1, 2000. Follow-up clinical evaluation was done on all patients.
RESULTS. There were 7 patients who underwent hemicraniectomy: 4 males and 3 females with a mean age of 61 years (range 29-80 years). The common risk factors were atrial fibrillation and valvular heart disease. Non-dominant MCA territory infarction was seen in 4 patients. On admission, the mean Glasgow score was 11 (range 9-14) which deteriorated to 9 (range 6-11) prior to surgery. The mean National Institute of Health Stroke Scale (NIHSS) score on diagnosis was 18 (range 16-20) which increased to 21 (range 18-25). Overall mortality was 28 percent. Mean follow-up period was 5 months (range 2-11 months) during which, all 5 patients had improved to moderate disability. Four patients were able to walk unassisted
CONCLUSION. Hemicraniectomy for malignant MCA infarction is a life-saving procedure and improves survival among patients. In the long term, this leads to significant improvement in the functional ability among survivors.