Annals of Indian Academy of Neurology
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Clinical evaluation of decompressive craniectomy in malignant middle cerebral artery infarction using 3D area and volume calculations

1 Department of Neurosurgery, Bezmialem Vakıf University, Istanbul, Turkey
2 Department of Neurosurgery, Memorial Şişli Hospital; Department of Physical Therapy and Rehabilitation, School of Health Sciences, GeliŞim University, Istanbul, Turkey
3 Department of Biomedical Engineering Department, Istanbul Medipol University, Istanbul, Turkey
4 Department of Biostatistics and Medical Informatics, Koç University, Istanbul, Turkey
5 Department of Neurosurgery, Yenimahalle Training and Research Hospital, Ankara, Turkey
6 Department of Neurosurgery, Manisa State Hospital, Manisa, Turkey

Correspondence Address:
Serdar Çevik,
Memorial Şişli Hospital, Piyalepaşa Bulvarı No: 4, Şişli - 34385, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_518_20

Objective: We aimed to measure the craniectomy area using three-dimensional (3D) anatomic area and volume calculations to demonstrate that it can be an effective criterion for evaluating survival and functional outcomes of patients with malignant middle cerebral artery (MCA) infarction. Material and Methods: The patients diagnosed with malignant ischemic stroke between 2013 and 2018, for which they underwent surgery due to deterioration in their neurological function, were retrospectively reviewed. Radiological images of all patients were evaluated; total brain tissue volume, ischemic brain tissue volume, total calvarial bone area, and decompression bone area were measured using 3D anatomical area and volume calculations. Results: In total, 45 patients (27 males and 18 females) had been treated with decompressive craniectomy (DC). The removed bone area was found to be significantly related to the outcome in patients with MCA infarction. The average decompression bone area and mean bone removal rate for patients who died after DC were 112 ± 27 cm2 and 20%, whereas these values for surviving patients were 149 ± 29 cm2 and 26% (P = 0.001), respectively. At the 6-month follow-up, the average decompression bone area and mean bone removal rate for patients with severe disability were 126 ± 30 cm2 and 22.2%, whereas these values for patients without severe disability were 159 cm2 ± 26 and 28.4% (P = 0.001), respectively. Conclusion: In patients with malignant MCA infarction, the decompression area is associated with favorable functional outcomes, first, survival and second, 6-month modified Rankin scale score distribution after craniectomy.

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    -  Kitis S
    -  Çevik S
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    -  Baygül A
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