Maximum Decompressive Hemicraniectomy for Patients with Malignant Hemispheric Infarction.

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Malignant hemispheric infarction (MHI) is a severe neurological condition with high mortality.
• Surgical decompression aims to reduce intracranial pressure and improve outcomes in MHI.

Purpose of the Study:

• To evaluate the functional outcomes of maximum external decompression in patients with MHI.
• To compare outcomes based on patient age, specifically younger (≤60 years) versus elderly (>60 years).

Main Methods:

• Twenty-five MHI patients underwent hemicraniectomy with maximum external decompression.
• This included large craniectomy, temporalis muscle resection, expansive duraplasty, and skin flap approximation.
• One-year functional outcomes were assessed using the modified Rankin Scale (mRS).

Main Results:

• The overall mortality rate was low (8.0%).
• Younger patients (≤60 years) showed significantly better functional outcomes (57.1% mRS ≤3) compared to elderly patients (9.1% mRS ≤3) (p=0.033).
• Elderly patients predominantly experienced unfavorable outcomes (mRS ≥4).

Conclusions:

• Maximum external decompression via hemicraniectomy increases survival and functional independence in younger MHI patients.
• This surgical approach is considered optimal for younger individuals with malignant hemispheric infarction.
• Age is a significant determinant of functional outcome following decompressive surgery for MHI.