Malignant MCA infarction: clinical outcomes and prominent predictive factors after decompressive craniectomy

Abstract Aim In our study, we aimed to evaluate the clinical outcomes and survival rates of patients who underwent decompressive craniectomy due to malignant middle cerebral artery (MCA) infarction and to identify the factors affecting these outcomes. Material and methods Between June 2019 and June 2024, we retrospectively evaluated 84 patients who underwent decompressive craniectomy due to malignant MCA infarction. The surgical team performed decompressive craniectomy on 51 patients (60.7%) while 33 patients (39.3%) underwent both decompressive craniectomy and temporal lobectomy. Demographic data, clinical parameters, imaging findings, surgical approach, recanalization status and Glasgow Outcome Scale (GOS) scores were recorded. Results The mean age of our patients was 69.4 ± 11.3. The median initial GCS (Glasgow Coma Scale) score was 11. The 12-month mortality rate for all patients reached 78.6% as 66 out of 84 patients died. In the study, patients aged 60 years and older (OR: 6.75, p = 0.008) and patients with a low initial GCS score (OR: 0.74, p = 0.011) and patients with systemic diseases (OR: 4.22, p = 0.029), and patients using anticoagulants (OR: 4.71, p = 0.018) and those with hemorrhagic infarction type (OR: 3.67, p = 0.035) had a higher mortality risk. We observed that early surgical intervention (≤ 12 h), successful recanalisation (OR: 7.92, p = 0.004), and endovascular interventions reduced mortality. 94.4% of survivors required full-time care. We observed adverse psychosocial effects and a significant economic burden on families. Conclusions We found that higher initial GCS scores, younger age, and the absence of comorbidities were associated with better clinical outcomes in malignant MCA infarction. Clinical and demographic characteristics of the patient play an important role in the surgical decision and prognosis prediction.