Malignant Middle Cerebral Artery Infarction Decompressive Craniectomy Score: A Prognostic Model for Malignant Middle...

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Malignant middle cerebral artery infarction (MMI) presents a high risk of mortality and disability.
• Decompressive hemicraniectomy (DC) is a life-saving procedure but patient outcomes vary significantly.
• Predictive tools for prognostication after DC in MMI patients are currently lacking.

Purpose of the Study:

• To identify independent predictors of outcome in MMI patients undergoing DC.
• To develop a pragmatic, bedside prognostic tool for MMI patients treated with DC.

Main Methods:

• Retrospective analysis of 318 MMI patients treated with DC across four Swedish university hospitals (2008-2022).
• Data collection included demographic, preoperative, and postoperative variables.
• Ordinal logistic regression analysis was used to identify predictors of 6-month modified Rankin Scale (mRS), forming the MMI-DC (MAD) score.

Main Results:

• A significant proportion of patients (76%) had unfavorable outcomes (mRS 4-6) at 6 months post-DC.
• The MAD score incorporates age (≥60), female sex, low Glasgow Coma Scale (GCS M <4), and impaired pupillary reactivity.
• Higher MAD scores correlated with significantly worse functional outcomes and increased mortality rates.

Conclusions:

• Decompressive hemicraniectomy for MMI is associated with a high rate of unfavorable outcomes.
• The MMI-DC (MAD) score demonstrates internal reliability as a prognostic tool for MMI patients undergoing DC.
• Further external validation of the MAD score and investigation into the predictive value of female sex are warranted.