Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery

• Published in: Scientific reports 2014-11, Vol.4 (1), p.7070-7070, Article 7070
• Main Authors: Lu, XiaoCheng, Huang, BaoSheng, Zheng, JinYu, Tao, Yi, Yu, Wan, Tang, LinJun, Zhu, RongLan, Li, Shuai, Li, LiXin
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/699/375; 692/699/375/534; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Cerebral infarction; Decompressive Craniectomy - methods; Follow-Up Studies; Humanities and Social Sciences; Humans; Infarction, Middle Cerebral Artery - mortality; Infarction, Middle Cerebral Artery - pathology; Infarction, Middle Cerebral Artery - surgery; Mortality; multidisciplinary; Neurosurgery; Science; Skull; Stroke; Surgery
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/srep07070

Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction.