Newly Suggested Surgical Method of Decompressive Craniectomy for Patients With Middle Cerebral Artery Infarction

Objectives: The purpose of this study is to suggest the landmarks for decompressive craniectomy so that surgery can be standardized to achieve adequate decompression in patients with malignant middle cerebral artery infarction. We also analyzed the efficacy and safety of this newly suggested surgical method. Methods: Eleven patients (group A) underwent this newly suggested decompressive surgery. The bony landmarks for decompressive craniectomy are described. The area of the bone flap and the brain volume protruding out of the skull surface were measured. The outcomes were evaluated 3 months after the surgery. All the results were compared with that of 13 patients (group B) who were treated with conventional surgical methods. Results: The mean area of craniectomy was larger in group A (399.9 +/- 50.9 cm(2)) than that in group B (308.5 +/- 50.5 cm(2), P = 0.021). The brain volume protruding out of the skull surface was 161.8 +/- 101.7 cm(3) in group A and 106.3 +/- 55.1 cm(3) in group B, indicating that more decompression was performed in group A (P = 0.034). Six (54.5%) of 11 patients in group A had favorable outcomes (modified Rankin Scale 0 to 3) without mortality, whereas 2 (15.4%) of 13 patients in group B had favorable outcomes and 3 (23.1%) patients in group B expired. Conclusion: Decompressive craniectomy using the newly suggested method is feasible and safe, and it may be more beneficial, compared with conventional craniectomy, for patients with malignant middle cerebral artery infarction. Furthermore, it may be easier to perform by training neurosurgeons.