Decompressive hemicraniectomy for malignant middle cerebral artery infarct

days and reaches its maximum level on the fourth day with a malignant middle cerebral artery infarct (3, 17).All kinds of conservative treatment are used in these cases to no avail and mortality rates up to 80% are seen as a result of herniation (2, 8).Malignant cerebral edema usually does not respond to medical treatment.Decompressive hemicraniectomy can be a life-saving procedure in such cases (11).However, it is not certain which cases will benefit from decompressive hemicraniectomy and attempts to determine such cases continue in published series (6,9,12,16,20,21).Cases that benefit from decompressive hemicraniectomy the most are those under the age of 60 with a preoperative admission Glasgow Coma █ INTRODUCTION M alignant hemispheric infarction usually develops due to acute internal carotid artery or middle cerebral artery (MCA) occlusion and has high a mortality rates.A mass effect develops due to brain edema following local brain swelling in ischemic stroke.The subtypes of edema are vasogenic, cytotoxic and interstitial.All these subtypes play a role in severe ischemic stroke but the most important one is cytotoxic edema.Cytotoxic edema is the result of cell swelling due to decreased oxygen causing a failure in the supply of substrates and energy and ultimately the ion pumps.Serious brain swelling usually emerges between the second and fifth AIM: Decompressive hemicraniectomy for a malignant middle cerebral artery infarct can be a life-saving surgical treatment.We aimed to investigate the surgical treatment results in cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct in this study. MATERIAL and METhODS:The clinical condition, radiological findings and surgical treatment results of 42 cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct were retrospectively evaluated in this study.RESULTS: There were 19 males and 23 females.The age range was 27 to 78 years with a mean age of 57.6 years.The infarct area was the non-dominant hemisphere in 20 cases and the dominant hemisphere in 22 cases.Preoperative Glasgow coma scale (GCS) scores were 5 to 12.The 42 cases with a malignant middle cerebral artery infarct were divided into 2 groups according to the Glasgow outcome scale (GOS) as the unfavorable outcome group (Group 1) with a score of 1 to 3 and the favorable outcome group with a score of 4 to 5 (Group 2).There were 27 cases in Group 1 and 15 in Group 2. There was a statistically significant association between a good result and age, Glasgow coma scale at the time of surgery, duration until surgery, and non-dominant hemisphere involvement.All cases with a Glasgow coma scale score of 7 or below had a poor outcome.CONCLUSION: Decompressive hemicraniectomy in malignant middle cerebral artery infarct can be a life-saving procedure but is not useful in cases with a Glasgow coma scale score of 7 and below.