{"id":"cffb281f-f0c9-470d-a8f6-89219d70a76e","slug":"hemicraniectomy-in-the-management-of-malignant-middle-cerebral-artery-infarction-lessons-from-randomized-controlled-trials","title":"Hemicraniectomy in the management of malignant middle cerebral artery infarction: Lessons from randomized, controlled trials","authors":["Dustin Hatefi","Brian Hirshman","Didier Leys","Jean-Paul Lejeune","Lawrence Marshall","Bob S. Carter","Ekkehard Kasper","Clark C. Chen"],"abstract":"Background: Territorial middle cerebral artery (MCA) infarcts are associated with high mortality rates and significant disability due to life-threatening cytotoxic edema. Hemicraniectomy is often performed as a life-preserving measure for patients experiencing intractable intracranial hypertension. The efficacy of this surgical intervention is documented in several randomized controlled trials (RCTs), although the functional outcomes for surviving patients remain controversial. Methods: Seven published RCTs were reviewed, evaluating hemicraniectomy for malignant MCA infarction. These studies included diverse patient populations with varying inclusion and exclusion criteria, focusing on mortality and functional outcomes measured by the modified Rankin Scale (mRS) at one-year follow-up. Statistical analyses were conducted to compare outcomes between surgical and medically managed groups. Results: The RCTs demonstrated a significant reduction in mortality associated with hemicraniectomy, with rates decreasing from 46-75% to 12-27%. Functional outcomes varied, with some studies showing improved mRS scores in surgical patients, while others indicated no significant difference. Notably, the outcomes were less favorable for patients over 60 years of age, suggesting age and timing of surgery are critical factors. Conclusion: Hemicraniectomy can significantly reduce mortality in patients under 60 years with malignant MCA infarcts, but its impact on functional outcomes is mixed and less favorable in older populations. Future studies should aim for uniform entry criteria and consider more comprehensive measures of functional status beyond the mRS. Keywords: hemicraniectomy, malignant MCA infarction, randomized controlled trials, mortality, functional outcomes, modified Rankin Scale, ischemic stroke","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/cffb281f-f0c9-470d-a8f6-89219d70a76e/featured/hero-1782420948411.png","publishDate":"2014-05-15T00:00:00.000Z","doi":"10.4103/2152-7806.132589","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/cffb281f-f0c9-470d-a8f6-89219d70a76e/pdf"}