Decompressive Craniotomy for Malignant Middle Cerebral Artery Infarction: A Prospective Cohort Study

Objective: The mortality for malignant middle cerebral artery infarcts(MCA) is very high. Decompressive craniotomy(DC) seems to reduce mortality, but the quality of life is still a current debate. We presented the results of patients with malign MCA infarction who were treated medically or surgically in our high-volume tertiary hospital. Material and Method: The study was a prospective cohort. DC was recommended to every patient who met the criteria, and those who did not accept were followed as the control medical treatment group. We evaluated the patients in the pre-operative and early, 1st/3rd/6th/12th months postoperative periods. Result: Forty-two patients were included in the study (17/surgery, 25/medical). Survival rates of those who received DC in each follow-up period were higher than those who received only medical treatment. This difference was also significant at the postoperative 1st, 3rd, and 6th months. In addition, the modified-Rankin-Scale examination showed that DC was superior in each control period. Conclusion: The fact that the mortality of the patients who underwent DC in our study (although lower than those who were treated only medically) was higher than in the other series can be explained by the poor neurological condition at the time of surgery. It should not wait until the patient's condition deteriorates too much to make an indication for surgery. For this purpose, it is necessary to inform the neurosurgeon of the decrease in the neurological condition of the patients with frequent examinations in the early period. Referring patients with the possibility of worsening to the neurosurgery clinic may be an alternative solution.