Functional outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions: a systematic review

Abstract

Decompressive hemicraniectomy has been used increasingly in recent years to treat malignant middle cerebral artery territory infarction. This review examines functional outcome data, with the novel analysis of outcomes according to temporal periods post-surgery. Case series data were pooled to determine significant correlates of outcome. Severe disability was frequently the outcome among survivors within one month post-surgery. Time and rehabilitation were later reflected, with fewer deaths and the emergence of mild to moderate disability increasing in prevalence. Mortality and severe disability were consistently more probable with increasing age. Presurgical clinical status in the form of additional cerebral artery involvement and midline shift also correlated with mortality within the 30-day period post-stroke.

Keywords::

• middle cerebral artery
• stroke
• craniectomy
• functional outcome

Acknowledgement

Thanks to Dr Martin Dempster, Research Coordinator, Doctorate in Clinical Psychology, Queen's University Belfast, for his help with the statistical analysis.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article