Maisie is eligible for decompressive surgery as:
- Updated evidence no longer supports an age cut-off for surgery (NICE, 2019)
- Is within 48 hrs of symptom onset
- Her CT scan shows severe MCA territory infarct with massive cerebral oedema, with a score above 15 on the National Institutes of Health Stroke Scale (NIHSS) stroke severity score.
Patients with stroke involving the MCA territory and complicated massive cerebral oedema comprise a small proportion (2 – 8%) of the overall number of patients with stroke. Younger patients tend to be over represented in this group and the untreated mortality is very high (up to 80%).
Pooled analysis of the data from randomised controlled trials (RCT) of hemicraniectomy for malignant MCA infarction found significantly reduced mortality with hemicraniectomy. Malignant middle cerebral artery (MCA) infarction is a devastating condition leading to early death in nearly 80% of cases due to the rapid rise of intracranial pressure despite maximum medical management of the ischaemic brain oedema.
Page last reviewed: 04 Mar 2021
