Decompressive surgery for malignant middle cerebral artery infarcts: the results of randomized trials can be...

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Randomized controlled trials (RCTs) demonstrate decompressive surgery (DS) for malignant middle cerebral artery (MMCA) infarcts reduces mortality by 50% and improves functional outcomes.
• The real-world effectiveness and reproducibility of DS for MMCA in clinical practice remain unevaluated.
• This study addresses the gap in knowledge regarding DS for MMCA outcomes outside of controlled trial settings.

Purpose of the Study:

• To evaluate the hypothesis that decompressive surgery for malignant middle cerebral artery infarcts yields similar results in clinical practice as observed in randomized controlled trials.
• To assess the reproducibility of DS for MMCA outcomes in a non-trial setting.

Main Methods:

• Prospective observational study including 31 patients undergoing DS for MMCA.
• Patient selection criteria mirrored those used in relevant meta-analyses.
• Primary outcome: modified Rankin Scale (mRS) score ≤4 at 1 year. Secondary outcomes: mRS ≤3 and mortality at 1 year.

Main Results:

• Of 31 patients, 22 (71.0%) achieved a 1-year mRS score of ≤4.
• 16 patients (51.6%) had a 1-year mRS score of ≤3.
• The 1-year mortality rate was 22.6% (7 patients).

Conclusions:

• Decompressive surgery for malignant middle cerebral artery infarcts in a center without prior experience achieved outcomes comparable to those in the surgical arm of RCTs.
• This observational study supports the efficacy of DS for MMCA in routine clinical practice.
• The findings suggest that DS for MMCA is a reproducible intervention with similar benefits to those reported in clinical trials.