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SUBJECTS AND METHODS

M alignant middle cerebral artery (MCA) infarction is used to describe the rapid neurological worsening that occurs because of the effects of a space-occupying cerebral edema secondary to a MCA territory stroke. It is a potential lethal clinical condition that has a poor outcome and mortality of ≈80% without surgical treatment. 1 Decompressive craniectomy (DC) is increasingly being used to avoid the harmful consequences of cerebral edema and intracranial pressure elevation in cases of malignant brain ischemia. 2–4 This treatment has been consistently associated with a decrease in mortality; however, the benefits in terms of functional outcome remain uncertain. A post hoc analysis of pooled data from 3 randomized control trials showed that patients who underwent surgery <48 hours after stroke have better functional outcomes compared with those operated later. 5 Therefore, DC seems to be more than just an optional intervention for malignant MCA infarction. Although this surgical procedure has been validated, few studies have evaluated the effects of DC on cerebral hemo-dynamics. 6–14 Specifically, the hemodynamic effects of DC in patients with MCA infarction remain unclear. Additional knowledge regarding cerebral hemodynamics in different clinical situations will allow us to understand the pathophysi-ology of the disease and improve the decision-making process for patients with malignant MCA infarctions. Our hypothesis was that DC would improve cerebral hemodynamics and, in patients with favorable outcomes, would have greater hemo-dynamic improvement. Therefore, we used pre-and postop-erative perfusion CT (PCT) to investigate the hemodynamic changes that may occur in patients with malignant MCA infarction after DC and their relationship with outcomes. The absolute values of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV) were used to assess the hemodynamic changes after DC, whereas the ratios of the post-and preoperative parameters of MTT, CBF, and CBV were used to assess whether the level of hemodynamic improvement was related to outcomes. This was a single-center, prospective cohort study. The patients were consecutively enrolled at the emergency room of a tertiary hospital. and the patients had a 6-month follow-up after the surgical procedure. Background and Purpose—Decompressive 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 …