Evaluation of the Effectiveness of Decompressive Craniotomy in Middle Cerebral Artery Infarction

Background: Middle cerebral artery infarction (MCA) represents up to 10–15% of all strokes. The deterioration in the conscious level usually noticed with the start of edema and midline shift within the first 48 hours. Wide controversy about decompressive surgery for those patients is still present. Objective: Detection of effectiveness of decompressive craniotomy in MCA infarction patients regarding the mortality and functional outcome. Patients and Methods: From January 2011 to June 2014, twenty patients, having MCA infarction, were prospectively studied. They were evaluated initially by CT brain, MRI diffusion and clinical assessment using Glasgow coma scale (GCS). They were operated by wide craniotomy, wide durotomy and release snipping of the dural edge above the cortical veins to prevent the venous obstruction by the dural edge against the bulging brain then duroplasty using the temporalis fascia graft. Barthel index and Modified Rankin scales were used to assess the functional outcome postoperatively and six months later. Results: Mortality was 10% in the 1st month and increased to 20% in the first 6 months atier surgery. Factors that affect the mortality and the functional outcome were age, pretreatment GCS, timing of surgery, presence of clinical signs of herniation, regaining of the consciousness within 10 days, side of the infarction and its extent. Conclusion: Decompressive craniotomy can save the life and improve the functional outcome in MCA infarction patients. It has the same results like the decompressive craniectomy with consideration in the surgery decision about the age, rapid decision and intervention, side of the infarction and its extent to get better functional outcome.