Salvage decompressive craniectomy in malignant MCA infarcts - Results of local experience at Shifa International Hospital, Islamabad, Pakistan

Malignant infarctions of the middle cerebral artery (MCA) have high mortality. Recent studies showed decreased mortality with good functional outcome in young people with decompressive surgery. We report prospective, non-randomized case series of live patients in whom successful life saving decompressive craniectomy was performed. All five were males. Mean age was 59.2 ± 13 years. Four had right MCA infarction while I had left MCA infarction. Ipsilateral temporoparietal craniectomy with duraplasty was performed in mean time of 76 ± 27 hours after onset of symptoms. Four (80%) patients were discharged to home in awake, alert, conversant, hemiparetic state. One patient developed status epilepticus, and was transferred to another facility in intubated. sedated state. Three month follow-up on three patients showed moderate improvement in neurological status. Early craniectomy was life saving in all of our patients. Neurosurgical intervention should be considered early in large MCA infarcts, especially in young patients.