{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T01:51:08Z","timestamp":1777513868146,"version":"3.51.4"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Malignant middle cerebral artery (MCA) infarction is associated with high mortality, mainly due to intracranial hypertension. This malignant course develops when two-thirds or more of MCA territory is infarcted. Randomized clinical trials demonstrated that in patients with malignant MCA infarction, decompressive craniectomy (DC) is associated with better prognosis. In these patients, some prognostic predictors are already known, including age and time between stroke and DC. The size of bone flap was not associated with long-term prognosis in the previous studies. Therefore, this paper aims to further expand the analysis of the bone removal toward a more precise quantification and verify the prognosis implication of the bone flap area\/whole supratentorial hemicranium relation in patients treated with DC for malignant middle cerebral infarcts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>This study included 45 patients operated between 2015 and 2020. All patients had been diagnosed with a malignant MCA infarction and were submitted to DC to treat the ischemic event. The primary endpoint was dichotomized modified Rankin scale (mRS) 1 year after surgery (mRS\u22644 or mRS&gt;4).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Patients with bad prognosis (mRS 5\u20136) were on average: older and with a smaller decompressive craniectomy index (DCI). In multivariate analysis, with adjustments for \u201cage\u201c and \u201ctime\u201d from symptoms onset to DC, the association between DCI and prognosis remained.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>In our series, the relation between bone flap size and theoretical maximum supratentorial hemicranium area (DCI) in patients with malignant MCA infarction was associated with prognosis. Further studies are necessary to confirm these findings.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_895_2022","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T08:40:09Z","timestamp":1671180009000},"page":"580","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Decompressive craniectomy index: Does the size of decompressive craniectomy matter in malignant middle cerebral artery infarction?"],"prefix":"10.25259","volume":"13","author":[{"given":"Thiago Pereira","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana Athaniel Silva","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Radiology, Albert Einstein Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo Favi","family":"Bocca","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feres Eduardo","family":"Chaddad-Neto","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Cavalheiro","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edson Amaro","family":"Junior","sequence":"additional","affiliation":[{"name":"Department of Radiology, Albert Einstein Hospital, S\u00e3o Paulo, 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