gms | German Medical Science

Objective: Decompressive craniectomy (DC) is an established life-saving surgical measure for malignant cerebral infarction (MCI), with randomized controlled trials showing case fatality reduction by 50-75% compared to best medical therapy. Timing of surgery is considered to be crucial, with studies advocating to perform DC within the first 48 hours after ictus. In this study, we aim to elucidate whether early (within the first 24 hours) and ultra-early (within the first 12 hours) DC can reduce mortality and improve outcomes in MCI.

Methods: We conducted a retrospective study of patients undergoing DC for MCI at our institution from 01/2011-03/2019, and stratified them into three groups according to the interval between ictus and DC: (a) ≤12 hours, (b) >12≤24 hours, (c) >24 hours, and compared them through a one-way ANOVA test in terms of mortality and outcome, as objectivized with the modified Rankin scale (mRS) at discharge.

Results: A total of 111 patients were included. Of these, 26, 23% underwent ultra-early DC, 34, 31% early DC, and 51, 46% late DC. Mortality in the ultra-early group was 50% (13/26), 32% (11/34) in the early group, and 29% (15/51) in the late group. In the ultra-early group, 6, 23% achieved mRS ≤3; in the early and late group, good outcome was achieved by 6, 17%, and 10, 20%, respectively. No statistically significant difference was observed in terms of mortality (p=.189) or outcome (p=.874) between the groups.

Conclusion: Our study suggests no additional benefit in terms of mortality and outcome from performing ultra-early (within 12 hours) and early (within 24 hours) DC in MCI. Further studies are needed to determine the best timing for DC in MCI.