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Updated: Aug 6, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Outcome after decompressive craniectomy in patients with severe ischemic stroke
S Harscher1, R Reichart, C Terborg
1Department of Neurology, Friedrich-Schiller-University Jena, Jena, Germany. Stefan.Harscher@med.uni-jena.de
Insights
Decompressive craniectomy for space-occupying middle cerebral artery (MCA) infarction reduces mortality and improves outcomes. Age and comorbidities predict prognosis in these stroke patients.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Space-occupying middle cerebral artery (MCA) infarction presents a significant mortality risk.
- Decompressive craniectomy is a potential intervention to mitigate this risk.
- Predictors of prognosis following this procedure require further elucidation.
Purpose of the Study:
- To evaluate mortality rates and functional outcomes after decompressive craniectomy for MCA infarction.
- To identify prognostic predictors in patients undergoing this surgical intervention.
- To assess the efficacy of hemicraniectomy in a clinical setting.
Main Methods:
- Retrospective analysis of 30 patients undergoing craniectomy for MCA infarction (1996-2002).
- Assessment of functional outcome using Barthel Index, modified Rankin Scale, and extended Barthel Index.
- Correlation of mortality and functional outcome with patient age and comorbidities.
Main Results:
- Overall mortality was observed, with early deaths due to herniation and later deaths from complications.
- 16 patients survived with a mean follow-up of 2.1 years.
- Mortality was linked to advanced age and higher comorbidity burden; functional outcome also depended on comorbidities.
Conclusions:
- Decompressive craniectomy for space-occupying MCA infarction appears to decrease mortality and improve functional outcomes.
- Age and comorbidities are significant predictors of prognosis.
- Further randomized trials are warranted to confirm indications, timing, and refine prognostic understanding.
Abstract:
Decompressive craniectomy after space occupying infarction of the middle cerebral artery (MCA) tends to decrease mortality and increase functional outcome. The aim of this retrospective study was to evaluate mortality rates and functional outcome in our centre and to identify predictors of prognosis. The charts of 30 consecutive patients (6 women, 24 men, mean age 59.3 +/- 11.0 years) who underwent craniectomy after space occupying MCA-infarction from 1996 to 2002 were analyzed. Functional outcome was assessed by semistructured telephone interview as Barthel-Index, modified Rankin scale and extended Barthel-Index. Five patients (mean age 67.2 +/- 6.1 years) died within 5.2 +/- 2.4 days (range 2-8 days) after the first symptoms due to herniation. Nine patients (mean age 63.1 +/- 7.1 years) died 141.0 +/- 92.5 days (range 40-343) after stroke onset due to internal complications. 16 patients survived (mean surviving time 2.1 +/- 1.5 years, mean age 54.1 +/- 11.4 years). Mortality was related to age and the number of risk factors/comorbidity, and functional outcome was dependent on the number of risk factors/comorbidity. Our small observational, retrospective study suggests that hemicraniectomy in patients with space occupying MCA-infarction decreases mortality rate and increases functional outcome. Further randomized trials may prove useful to better define the indications, timing and prognosis for this procedure.
