Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery

Object. The goal of this study was to determine the frequency of hemicranie ctomy-associated lesions and their. potential effect on the risk of mortali ty in patients suffering from malignant infarction of the middle cerebral a rtery (MCA). Methods. The authors evaluated serial computerized tomography scans obtaine d in 60 patients with complete infarction of the right MCA who were treated using hemicraniectomy. The maximum diameter of the hemicraniectomy was det ermined and the hemicraniectomy-associated lesions were classified as ische mic lesions or hemorrhages. The category of hemorrhages was composed of par enchymal, subdural, or epidural/subgaleal hematomas. Parenchymal hemorrhages and infarcts associated with hemicraniectomy occurr ed with frequency rates of 41.6% and 28.4%, respectively. The occurrence of hemicraniectomy-associated bleeding was related to the size of the hemicra niectomy performed; that is, the smaller the hemicraniectomy, the more ofte n lesions occurred (p < 0.05). Hemicraniectomy-associated bleeding was also related to an increased risk of mortality. Conclusions. Hemicraniectomy is an effective therapy in patients with malig nant infarction of the MCA. However, a hemicraniectomy that is too small in diameter may cause the formation of additional lesions and adversely affec t the risk of mortality and the quality of survival. In addition, the size and shape of the edges of the bone defect are important factors relating to its efficacy.