Analysis of outcome of decompressive craniectomy in patients with acute massive cerebrovascular accidents – an institutional analysis

Aims: The overall aim was to evaluate the outcome of decompressive craniectomy (DC) in patients with acute massive cerebrovascular accidents in a tertiary referral center with the primary outcomes being survival, functional ability and psychosocial consequences. Methods: The study was a retrospective study over the last four years. Data derived from case sheets, reports and operative notes. The main outcome measures were noted from Glasgow Scale (GCS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (MRC).Changes over time during follow-up were obtained by telephonic communication with patient. Analysis was done using a statistical method that is suitable for small data sets. Results: The retrospective data was analyzed for a period of four years, of which 51.11% patients had ischaemic stroke and 48.89% had intracranial hemorrhage respectively. All patients who underwent decompressive craniectomy survived and did well with the surgery 85.07% people improved to MRC scale of 3 and 14.93% patients expired due to secondary causes such as MI aspiration pneumonia etc which occurred duringhospitalization. The therapeutic algorithms, time to tracheotomy time to cranioplasty were also noted. The control group who received only medical management saw only 1.5% survival. Conclusions: The studies show that an effective chain of medical surgical and rehabilitation activities can produce a good outcome/living situation and that life can be satisfactory for patients after massive cerebrovascular accidents in spite of neurological deficits.