Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction: Functional Outcomes at One Year
DOI:
https://doi.org/10.5281/zenodo.22310441Keywords:
Decompressive craniectomy, Malignant middle cerebral artery infarction, Modified Rankin Scale, Functional outcome, HemicraniectomyAbstract
Background: Malignant middle cerebral artery infarction causes life-threatening cerebral edema; untreated mortality
approaches 80%. Decompressive craniectomy reduces death, but survival often comes with substantial residual disability.
Objective: To synthesise trial and cohort evidence on one-year functional outcome after decompressive craniectomy for
malignant middle cerebral artery infarction. Methods: Narrative review of pivotal trials (DECIMAL, DESTINY, HAMLET, DESTINY II, HeADDFIRST), their pooled and individual-patient-data meta-analyses, and quality-of-life and patient-perspective studies.
Findings: In patients under 60, surgery within 48 hours roughly halves mortality and increases the proportion achieving
modified Rankin Scale 4 or better, without increasing severely disabled survivors. In patients over 60, DESTINY II confirmed a
large survival benefit but little gain in independence; most survivors remained moderately to severely disabled. Quality-of-life and
retrospective-consent studies show many survivors and caregivers nonetheless endorse the decision to operate.
Conclusions: Decompressive craniectomy shifts, rather than eliminates, disability; counselling before surgery should reflect
reported patient experience alongside clinician judgement.
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