Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries

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Figure 1
Demographics of participating physicians.

Table 1

Survey answers per respondents’ specialty.

Character	Physician Specialty
Character	Neurology n=41	Intensive Care n=14	Neurosurgery n=32

	(%)
*Number of DC cases referred per year*
0-5	(56.1)	(57.1)	(37.5)
6-10	(14.6)	(7.2)	(21.9)
>10	(24.4)	(35.7)	(40.6)
*Number of DC cases performed per year at your center*
0-5	(73.2)	(50)	(43.8)
6-10	(14.6)	(21.4)	(31.3)
>10	(12.2)	(28.6)	(25)
*Preferred time for case referral to neurosurgery*
Immediate	(53.7)	(57.1)	(50)
Clinical Trigger	(9.8)	(7.2)	(12.5)
Imaging Trigger	(36.5)	(35.7)	(38.1)
*Role of ICP monitoring in malignant MCA syndrome cases*
No role	(29.3)	(0)	(6.3)
Somewhat helpful	(51.2)	(50)	(56.3)
Very helpful	(19.5)	(50)	(37.5)
*Most important trigger for referral for DC*
Clinical	(61.1)	(76.9)	(51.9)
Radiological	(16.7)	(0)	(11.1)
ICP increase	(2.8)	(7.7)	(18.5)
Neurosurgeon suggestion	(19.4)	(15.4)	(18.5)
*Timing of referral to neurosurgery in the absence of a trigger*
Not specific	(37.1)	(38.5)	(29.6)
Within 6 hours	(2.9)	(15.4)	(18.5)
12	(5.7)	(0)	(7.4)
24	(28.6)	(7.7)	(7.4)
Prophylactic is not offered	(25.7)	(38.5)	(37.1)
*What constitutes a good functional outcome (mRS score)*
3	(75)	(76.9)	(70.4)
4	(18.8)	(23.1)	(22.2)
5	(6.6)	(0)	(7.4)
*Effect of DC in your practice*
Same as natural history	(6.1)	(30.8)	(11.1)
Improves functional recovery	(33.3)	(15.4)	(14.8)
Improves survival	(60.6)	(53.4)	(74.1)
*What constitutes a contraindication to DC*
Age>60, or multiple territories	(60.6)	(53.9)	(80.8)
Dominant hemisphere	(15.2)	(15.4)	(7.7)
Pupillary changes	(24.2)	(30.7)	(11.5)

DC - Decompressive Craniectomy, ICP - Intracranial Pressure, MCA - middle cerebral artery, mRS - modified Rankin’s Scale