Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Malignant infarction of the middle cerebral artery (MCA) affects a subset of ischemic stroke patients.
• Early decompressive craniectomy (DC) is a potential treatment for malignant MCA infarction.

Purpose of the Study:

• To evaluate the functional outcomes of malignant ischemic stroke patients treated with DC.
• Comparison of DC versus conservative treatment (CT) in a Brazilian neurological emergency center.

Main Methods:

• Prospective cohort study of 25 patients with malignant MCA infarction.
• Patients were divided into DC surgical group and CT conservative treatment group.
• Functional outcome assessed using modified Rankin Scale (mRS) at six-month follow-up.

Main Results:

• Favorable outcomes (mRS ≤ 3) were seen in 37.5% of DC patients versus 29.4% of CT patients (p=0.42).
• Mortality was lower in the DC group (25%) compared to the CT group (52.8%), though not statistically significant.
• Moderate to severe disability (mRS 4–5) was more frequent in the DC group (37.5%) than the CT group (17.7%).

Conclusions:

• Decompressive craniectomy (DC) demonstrated perceived superiority over conservative treatment (CT) for malignant MCA infarction.
• The reduction in mortality with DC was associated with an increased proportion of patients experiencing moderate to severe disability.