• Robson Luis Amorim, Almir Ferreira de Andrade, Gabriel S Gattás, Wellingson Silva Paiva, Marcos Menezes, Manoel Jacobsen Teixeira, and Edson Bor-Seng-Shu.
• From the Division of Neurosurgery (R.L.A., A.F.d.A., W.S.P., M.J.T., E.B.-S.-S.) and Department of Radiology (G.S.G., M.M.), University of São Paulo Medical School, São Paulo, Brazil.
• Stroke. 2014 May 1;45(5):1375-80.

Background And PurposeDecompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes.MethodsTwenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied. The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC.ResultsThere was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post- and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift>10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters.ConclusionsDC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke.

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