Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery

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Abstract
Object. The goal of this study was to determine the frequency of hemicraniectomy-associated lesions and their potential effect on the risk of mortality in patients suffering from malignant infarction of the middle cerebral artery (MCA). Methods. The authors evaluated serial computerized tomography scans obtained in 60 patients with complete infarction of the right MCA who were treated using hemicraniectomy. The maximum diameter of the hemicraniectomy was determined and the hemicraniectomy-associated lesions were classified as ischemic lesions or hemorrhages. The category of hemorrhages was composed of parenchymal, subdural, or epidural/subgaleal hematomas. Parenchymal hemorrhages and infarcts associated with hemicraniectomy occurred with frequency rates of 41.6% and 28.4%, respectively. The occurrence of hemicraniectomy-associated bleeding was related to the size of the hemicraniectomy performed; that is, the smaller the hemicraniectomy, the more often lesions occurred (p < 0.05). Hemicraniectomy-associat...