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Published on: August 11, 2015
Decompressive hemicraniectomy in supra-tentorial malignant infarcts
Furqan A Nizami1, Altaf U Ramzan, Abrar A Wani
1Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Jammu and Kashmir, India.
Surgical Neurology International
|March 23, 2012
Summary
Early decompressive hemicraniectomy significantly reduces mortality and improves functional outcomes for patients with malignant brain infarcts compared to conservative medical management alone.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Supratentorial malignant brain infarcts (STMBI) often lead to increased intracranial pressure, necessitating interventions.
- Decompressive hemicraniectomy is a recognized procedure to reduce intracranial pressure, improve survival, and decrease morbidity in STMBI patients.
Purpose of the Study:
- To evaluate the effectiveness of surgical decompression in reducing mortality and morbidity in STMBI patients refractory to medical therapy.
- To compare surgical decompression outcomes with conservative medical management.
Main Methods:
- A cohort of 24 patients diagnosed with STMBI refractory to medical management were included.
- Patients were offered decompressive hemicraniectomy; those whose relatives declined surgery formed the medically managed control group.
Main Results:
- Mortality rates were 16.7% in the surgical group versus 25.0% in the medical group.
- Early surgery (<48 hours), younger age (≤60 years), less midline shift (<5 mm), and smaller infarct size (<2/3 vascular territory) correlated with better prognosis.
- Surgically treated patients showed superior functional outcomes (mRS, GOS) and depression scores (Zung SDS) at one year.
Conclusions:
- Early decompressive hemicraniectomy with duroplasty is effective in reducing mortality in STMBI patients.
- Surgical intervention improves functional outcomes compared to conservative medical management.
