Clinical Outcome in Malignant Middle Cerebral Artery Infarction by Decompressive Hemicraniectomy in Elderly

Abstract

Stroke is the most common cause of death and adult disabilities worldwide. In Thailand, stroke is the first and the third cause of death in females and males of all age group, respectively. Malignant Middle Cerebral Artery Infarction occurs in 1-10 percent of all stroke patients. The prognosis of these patients is poor, and the mortality rate may be as high as 80 percent. Several studies havesuggested that decompressive surgery, consisting of a hemicraniectomy and duroplasty, reduce mortality in patients with Malignant Middle Cerebral Artery Infarction. In a retrospective analytical study, recruitment of 21 patients suffering from Malignant Middle Cerebral Artery Infarction, whowere treated with decompressive hemicraniectomy in Pranangklao hospital was carried out between January 1, 2007 and March 31, 2012. The objective of this study was to investigate differennces of the mortality rate, length of stay (LOS), quality of life between older age group (age ≥ 60 years) and younger group (age < 60 years). Twenty- one patients were included in the present study. The medical records were reviewed and data collection on sex, age, side of hemispheric infarction, preoperative Glasgow Coma Scale (GCS), midline shift, Glasgow outcome scale (GOS) and modified Rankin score (mRS) were carried out. Statistical test used for data analysis were descriptive statistics, Fisher’s exact test and t-test. The over all mortality rate was 52.38 percent. There showed no significant change in mortality and LOS between the two groups. But quality of life by GOS and mRS showed significant difference between the two groups (p 0.035and p 0.004). Patients with lower GCS and midline shift >10 m.m. showed higher mortality rate significantly (p 0.002 and p 0.001).