A population-based registry study of outcome after decompressive hemicraniectomy in patients with malignant cerebral infarction in Norway

Abstract

Background: In a small group of the patients with Middle cerebral artery (MCA) thrombosis, the infarction will further develop for it to become of space-occupying malignant character. For these patients, decompressive hemicraniectomy (DHC) is an alternative for treatment. Treatment data from all hospitals in Norway has been registered in the Norwegian Stroke Registry (NSR) since 2017, creating a unique opportunity to perform a descriptive study. Methods: The study population was all stroke patients who had been treated with DHC in Norway in the years 2017-19. The primary outcome measure was the modified Rankin scale (mRS). Results: It was observed 68 patients with a median age of 57.5 years, of those 25 % women. The crude surgical rate was 0.43 per 100 000 population per year, with variation between the four health regions. The proportion of patients with an mRS score ≤3 after 3 months comprised 29.4 %. Conclusion: The low proportion of females, the geographic variation in surgical rates and the low proportion of inter-hospital transfers indicate inequalities in access to DHC. For patients who received the operation, the use was in accordance with recommendations in clinical guidelines, and the outcome was comparable with those reported from RCTs.