Decompressive hemicraniectomy versus medical treatment for malignant middle cerebral artery infarction: Eleven years experience in a Tunisian center

Objective: To compare Decompressive hemicraniectomy (DHC) versus medical treatment alone for malignant middle Cerebral Artery infarction (MMCAI) and to define factors associated with mortality in the surgery group. Methods: We conducted a monocenter retrospective study over 11 years including patients with MMCAI. We compared the surgery group versus the no-surgery group. Mortality was assessed at discharge. Functional outcomes were measured at discharge and after 90 days with the modified Rankin Scale. Results: We included 55 patients, 27 patients in the surgery group and 28 patients in the no-surgery group. Mortality at discharge was lower in the surgery group than in the no-surgery group 55.55% vs 64.28% but without statistical significance (p =0.58). Survivors have poorer outcome mRS (4-5) in the surgery group than the no-surgery group 44.44% vs 25% without significant difference (p = 0.17). At 90 days, mRS scores of 0 and 1 were not observed, and a score of 2 was observed in only 2 patients (3.6%) in the no-surgery group. mRS score of 3 was observed in 2 patients (3.6%) in the no-surgery group. We noted that patients in the surgery group had an increased number of patients with mRS 4 from 9 to 11 and decreased the number of patients with mRS 5 from 3 to 1. The independent factors associated with mortality in surgery group were age ≥60 years (p = 0.017, OR = 0.46, CI95% (0.04–0.57)) and choc (p = 0.036, OR = 0.96, CI95% (0.11–0.86)). Conclusion: DHC decreased mortality risk in a patient with MMCAI but without statistically significant differences and it was associated with poor functional outcomes.