Background:

Hemispheric large volume infarctions are at increased risk of herniation with 50 to 70 percent mortality. Timely decompressive craniectomy reduces the mortality by 50 percent.  Little is known about vocational status and the impact upon support givers and patients.

Methods:

This is a retrospective evaluation of all subsequent patients who underwent decompressive craniectomy for malignant middle cerebral artery (MCA) infarction at the Central India Institute of Medical Sciences from January 2011 till January 2018. Functional outcome was assessed on modified Rankin scale (mRS). Good outcome was defined as mRS 0-3 and poor outcome as mRS 4-6. We enquired whether patient was able to resume work. Family members were asked whether they were happy with the decision of surgery.

Results:

41 patients underwent decompressive craniectomy; information was available for 38 patients. Median age was 43 years (range 24-63). 33 (87%) were men. 25 (65.78%) had right hemispheric infarcts. The median follow up is 798 days (range 60 to 2566 days). 16 (42%) had good outcome (mRS 2= 3; mRS 3= 13). 22 (58%) had bad outcome (mRS 4= 9; mRS 5= 1; mRS 6= 12).  Four (10.5) patients resumed work (p<0.0001). These four patients were younger (median age 34 years). Family of 28 (74%) patients were happy with the decision for surgery while 10 (26%) regretted (p <0.05).

Conclusion:

Following decompressive craniectomy for malignant MCA infarction only 10 percent patients were able to resume work thus the family requires long term social support. Majority (75%) of the families were happy with the decision of surgery.

DECOMPRESSIVE CRANIECTOMY FOR MALIGNANT MIDDLE CEREBRAL ARTERY INFARCT: LONG TERM OUTCOME, VOCATIONAL STATUS AND FAMILY PERSPECTIVE