Outcome of decompressive craniotomy in malignant middle cerebral artery infarction: a retrospective study

Malignant middle cerebral artery (MCA) infarction, caused by complete Middle cerebral artery occlusion, produces extensive cerebral edema, that causes rapid neurological deterioration. Though the incidence of this entity is 1-10% of all MCA territory infarct, it has a high mortality of up to 80%. Decompressive craniotomy, as a measure to combat the edema is an established procedure. In this ten-year retrospective study, we performed decompressive craniotomy, as a lifesaving procedure, in 86 selected patients, under 65-year age, diagnosed with malignant MCA infarction, and compared our result with 68 patients, of same age group, treated solely on medical therapy. 92 patients were excluded from this study for age>65 years/ GCS<5/ dilated and non reacting pupil/ has taken rTPA, 12 hours prior to time of surgery plan. Our study result was also compared to other similar studies. We found the mortality is 25.58% in surgery group as compared to 48.53%, that of the patients treated medically. We concluded that craniotomy done within 48hours of admission definitely improves the mortality rate.