Objectives: Early decompressive hemicraniectomy in malignant middle cerebral artery (MCA ) syndrome is shown to improve long term clinical outcomes in patients. Longer hospitalization and ventilator days expose patients to increased risk of complications. We explore pertinent short term clinical predictors for the highest potential of functional recovery with acute rehabilitation in patients who present with malignant MCA syndromes requiring decompressive hemicraniectomy.
Methods: This is a retrospective review of 53 patients from 2008-2013 on patients with acute ischemic malignant MCA strokes who underwent decompressive hemicraniectomy. We quantified midline shifts on brain imaging obtained prior to surgery. The primary objective was identifying patient factors leading to acute rehabilitation compared to other discharge outcomes including long term acute care facilities (LTAC), subacute nursing facilities (SNF), or expiration.
Results: See Table.
Conclusions: Younger patients presenting with malignant MCA syndromes receiving decompressive hemicraniectomies at smaller midline shifts are observed to achieve less ventilator days, reduced hospital length of stay and discharge with optimal rehabilitation potential.