Decompressive craniectomy for treatment of malignant middle cerebral artery ischemic stroke: Surgical results in 34 cases [Malin Orta Serebral Arter İskemik Enfarktlarının Tedavisinde Dekompresif Cerrahi: 34 Olguda Cerrahi Sonuçlar]

Objective: we investigated the survival and prognosis of patients undergoing decompressive hemicraniectomy for treatment of malignant middle cerebral artery (mca) infarction to investigate the impact of early surgery on outcome. methods: the clinical data of 34 consecutive patients who underwent decompressive craniectomy for malignant mca infarction at our clinic from 1 january 2008 to 1 january 2014 were examined. the patient’s age,gender,area affected by the infarct,side of the infarct,glasgow coma scores (gcs) on admittance and prior to anesthesia,presence of anisocoria,volume of the infarct,size of craniectomy,interval from stroke onset to surgery,pre- and postoperative midline shift,as well as the patient’s medical history,including chronic diseases and previous drug therapies such as antithrombotic and anticoagulant medications,were recorded. the relationships between these parameters and mortality were investigated. results: data analysis of the 34 patients indicated no statistically significant differences in mortality according to age,gender,accompanying diseases,or side of the operation (p > 0.05). the survival rate was 26.5% (n = 9) with a mortality rate of 73.5% (n = 25). gcs before anesthesia,infarct volume,the presence of anisocoria,and postoperative midline shift were significantly different between subjects who survived versus did not survive. multivariate logistic regression analysis showed that anisocoria and infarct volume were independent risk factors for mortality in malignant ischemic stroke. conclusion: decompressive hemicraniectomy should be performed in patients before deterioration begins and clinical signs of herniation develop. © 2016,ege university press. all rights reserved.