Decompressive hemicraniectomy for malignant middle cerebral artery infarction: Experience from the Western Province of Saudi Arabia

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Figure 1
Case illustration of a 39-year-old male (case 4) who presented with left massive MCA infarction demonstrated on A) plain CT scan which was delineated by MRI diffusion B) and ADC scan C) due to occlusion of MCA (arrowhead) D). He underwent left decompressive hemicraniectomy E) and duraplasty (F). G) The bone flap was 17.6 x 14.3 cm in maximum diameter. H) Postoperative CT scan showing marked swelling of the infarcted tissue and (I) adequate bone decompression (arrow). The swelling has subsequently decreased in size over 2 weeks (arrow) (J).

Table 1

Summary of cases with malignant middle cerebral artery (MCA) stroke treated with decompressive hemicraniectomy

Case	Age (yr)/Sex	Risk factors for stroke	Hemisphere involved	Stroke to surgery time (hrs)	Immediate pre-operative GCS	24 hrs post-operative GCS	mRS at 12-months follow-up	BI at 12-months follow-up
1	48/F	DM, portal vein thrombosis	Right	120	11	15	3	60
2	54/M	DM & HTN	Right	3	4	3	6	0
3	6/M	sickle cell anemia	Right	64	7	10	4	15
4	39/M	HTN, DM, ischemic heart disease	Left	7	7	3	5	0
5	40/F	HTN	Left	91	9	3	6	0
6	57/M	DM, HTN, ischemic heart disease	Left	10	6	3	6	0