Malignant MCA Infarction: Clinical outcomes and prominent predictive factors after decompressive craniectomy

Background The research evaluated both clinical results and elements that influence survival rates among patients who received decompressive craniectomy because of malignant middle cerebral artery (MCA) infarction. Objective Between June 2019 and June 2024, 84 patients who underwent decompressive craniectomy for malignant MCA infarction were retrospectively analyzed. Methods Patients were grouped as decompressive craniectomy and decompressive craniectomy + temporal lobectomy (n = 18) according to the type of surgery. Demographic data, clinical parameters, imaging findings, surgical approach, recanalization status and Glasgow Outcome Scale (GOS) scores were recorded. Results The mean age of the patients was 69.4 ± 11.3 years and the median baseline GOS score was 11. Mortality rate was 78.6%. The study found that patients aged 60 years or older (OR: 6.75, p = 0.008) and those with low baseline GCS scores (OR: 0.74, p = 0.011) and systemic diseases (OR: 4.22, p = 0.029) and anticoagulant use (OR: 4.71, p = 0.018) and hemorrhagic infarct type (OR: 3.67, p = 0.035) had a higher risk of mortality. Early surgical intervention (≤ 12 hours), successful recanalization (OR: 7.92, p = 0.004) and endovascular interventions reduced mortality. Of the survivors, 94.4% required full-time care. In addition to the adverse psychosocial impact, the economic burden on families was substantial. Conclusions Higher baseline GCS score, younger age and absence of comorbidities are associated with better clinical outcomes in malignant MCA infarction. Clinical and demographic characteristics of the patient play an important role in the surgical decision and prognosis prediction.