• Nida Fatima, Sania Razzaq, Ahmed El Beltagi, Ashfaq Shuaib, and Maher Saqqur.
• Department of Neurosurgery, Hamad General Hospital, Doha, Qatar. Electronic address: Nfatima@stanford.edu.
• World Neurosurg. 2020 Jan 1; 133: e267-e274.

ObjectiveDecompressive craniectomy (DC) has been advocated as a lifesaving procedure in management of patients with raised intracranial pressure due to malignant ischemic stroke (MIS). The aim of this study was to identify comparative radiologic parameters after DC to predict functional outcome at 6 months in patients with MIS.MethodsA retrospective analysis (2015-2018) of patients (median age 54 years; range, 29-80 years) with MIS who underwent postoperative computed tomography within 24 hours of DC was performed. Multivariate regression analysis was computed to predict clinical outcome at 6 months based on the Glasgow Coma Outcome Scale Extended.ResultsWith median National Institutes of Health Stroke Scale score of 20 (range, 3-33), mean preoperative stroke volume was 250 ± 75 cm3. Median Glasgow Coma Outcome Scale Extended score at 6 months was 4. Multivariate regression analysis showed that the comparative radiographic characteristics of absence of effacement of cortical sulci (odds ratio 2.88; 95% confidence interval, 1.22-20.71; P = 0.02), absence of hemorrhagic transformation (odds ratio 1.09; 95% confidence interval, 1.99-12.89; P = 0.03), and absence of compression of lateral ventricles (odds ratio 3.75; 95% confidence interval, 1.28-22.4; P = 0.05) on postoperative computed tomography scan were significant independent predictors of good functional outcome (Glasgow Coma Outcome Scale Extended score 5-8).ConclusionsThe comparative radiographic characteristics of absence of effacement of cortical sulci, hemorrhagic transformation, and compression of the lateral ventricles after DC in patients with MIS bore a significant relationship to predicting clinical outcome at 6 months.Copyright © 2019 Elsevier Inc. All rights reserved.

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