Background: The skull is a non-expandable structure like a ‘closed box’ holding constant contents of blood, water, and precious brain tissue. Decompressive Craniectomy (DC) is a short simple life-saving procedure directed to open the “closed box” in patients with refractory intracranial hypertension. Whether to do it or not, is a matter of argument as making the right decision is a very difficult process.
This study aims to present how we selected the patients for such procedure based on our institution experience.
Methods: 75 patients with unilateral Middle Cerebral Artery (MCA) infarction who underwent decompressive craniectomy between 2014 and 2019 at Banha University were analyzed prospectively. The decision of surgery was discussed with the family based on the clinical and radiological basis. The modified Rankin Scale (mRS) was used to evaluate the clinical outcome.
Results: A 12-month follow-up revealed; that 30 patients had a mild disability or good outcome, 35 patients were vegetative or severely disabled, and 10 patients had died. Favorable prognostic factors were younger age and preoperative GCS score (9 or higher).
Conclusion:
Decompressive craniectomy in patients with unilateral MCA infarction is a simple life-saving procedure for patients with acute refractory elevated ICP after the failure of conservative measures to prevent fatal brain herniation and improves cerebral hemodynamics. Early DC with the dural expansion is more favorable in young patients. Decision-making and patient selection for DC is an important complex procedure that should be evaluated from many aspects. We designed Em-Li scale and recommend it as a useful tool to help the surgeon not to miss a hopeful patient and to avoid operating on the patient who will not get the benefit of DC as not to decompress is also the right decision.
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