Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors

Objective: The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. Material and methods: In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1 year, and at present was measured using the modified Rankin scale (mRS). Results: Patient age was shown to be directly related to the mRS (r = 0.56; p = 0.035) and 37.5% achieved a good outcome (mRS <= 3); 78.9% of the interviewed relatives would repeat the surgical decision. Conclusions: We present a 21 patients group where the best outcome was achieved in patients <= 60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients. (C) 2019 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.