Outcomes of Decompressive Craniectomy in Patients with Supratentorial Ischaemic Stroke: A Longitudinal Study

Abstract

Introduction: Decompressive Craniectomy (DC) is a surgical procedure that entails removing a section of the skull with the aim of preventing neuronal damage and improving the patient’s prognosis. The goal was to determine if DC is associated with reduced risk of death and improved outcomes. Aim: To study the outcome, morbidity and mortality associated with DC in patients with intracranial ischaemic infarct. Materials and Methods: A longitudinal single-centre study was carried in the Department of Neurosurgery, GR Medical College and JA Group of Hospitals, Gwalior, Madhya Pradesh, India, from January 2019 to June 2020. A total of 25 cases were operated on and subsequently followed-up. Patients who were admitted with life-threatening supratentorial infarction and deemed eligible for DC based on clinical assessment {National Institute of Health Stroke Scale, Glasgow Coma Scale (GCS)} and neuroimaging with computed tomography head or Magnetic Resonance Imaging (MRI) brain were prospectively included in the study. The outcomes of the study were evaluated based on the functional impairment experienced by patients after a stroke. This was assessed using the Modified Rankin Scale (mRS), a seven-point scale that ranges from 0 (no symptoms) to 6 (death). The assessments were conducted at discharge, three months and six months. Paired t-test was used to analyse the functional outcomes of patients at admission, discharge, 3-month, and 6-month follow-up, using the mRS as the tool of evaluation. The relationship between patient characteristics and neurological outcome was analysed using the Chi-square test. Results: In the study, 25 patients were analysed, with 76% being males. The right hemisphere was affected in 13 (52%) patients, while 12 (48%) patients had left hemisphere involvement. At admission, 23 (92%) patients had a mRS score of five and only 2 (8%) patients had an mRS score of 4. During hospitalisation, 8 (32%) patients died. After discharge, 7 (28%) patients had a mRS score of 4 or less, which increased to 9 (36%) patients at three months follow-up and 12 (48%) patients at six months follow-up. Conclusion: The results of the present study revealed that decompressive hemicraniectomy improved neurological outcomes of patients with supratentorial ischaemic infarcts, with patient characteristics playing a significant role.