• Luiz Severo Bem Junior, Veiga SilvaAna CristinaACNeuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil., Otávio da Cunha Ferreira Neto, Joaquim Fechine de Alencar Neto, Marcelo Diniz de Menezes, Júlia Lins Gemir, Luís Felipe Gonçalves de Lima, Maria Júlia Tabosa de Carvalho Galvão, Araruna DiasArtêmio JoséAJCollege of Medical Sciences, Unifacisa University Center, Campina Grande, Brazil., Fernandes SanchezLuana MouryLMUniversity Maurício de Nassau, Recife, Brazil., Nilson Batista Lemos, Silva DinizAndrey MaiaAMFederal University of Paraíba, João Pessoa, Brazil., Nivaldo Sena Almeida, Marcelo Moraes Valença, and Azevedo FilhoHildo Rocha Cirne deHRCDepartment of Neurosurgery, Hospital da Restauração, Recife, Brazil..
• Department of Neurosurgery, Hospital da Restauração, Recife, Brazil; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil; College of Medical Sciences, Unifacisa University Center, Campina Grande, Brazil. Electronic address: luizseverobemjunior@gmail.com.
• World Neurosurg. 2022 May 1; 161: e580-e586.

BackgroundMalignant ischemic stroke (MIS) occurs in a subgroup of patients with cerebrovascular accident who sustain massive or significant cerebral infarction. It is characterized by neurological deterioration owing to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used to treat select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, including timing of the procedure, and postoperative mortality.MethodsWe analyzed surgical characteristics associated with prognosis in 145 patients who underwent DC secondary to MIS between 2013 and 2018, assessing clinical outcome at discharge and 6 and 12 months after discharge. Our inclusion criteria were DC secondary to MIS in adult patients with raised intracranial pressure signs.ResultsOur analysis showed that although patients from cities >100 km from the neurosurgical center had a worse prognosis, only the surgical head side (left vs. right, P = 0.001), hospitalization length (P < 0.001), and earlier timing of procedure (P < 0.001) were statistically relevant in having worse outcomes.ConclusionsPatients in whom more time passed from presentation to the neurosurgical procedure, owing to living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of patients who underwent DC after an MIS.Copyright © 2022 Elsevier Inc. All rights reserved.

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