Acta Neurochirurgica

, Volume 159, Issue 2, pp 301–306 | Cite as

Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction

  • Jarle SundsethEmail author
  • Antje Sundseth
  • Eva Astrid Jacobsen
  • Are Hugo Pripp
  • Wilhelm Sorteberg
  • Marianne Altmann
  • Karl-Fredrik Lindegaard
  • Jon Berg-Johnsen
  • Bente Thommessen
Original Article - Vascular



Swollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction.


All patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size.


Fourteen out of 45 patients (31%) died during the primary hospitalization (range, 3–44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01–0.77; p = 0.029).


The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.


Decompressive craniectomy Swollen Middle cerebral artery infarction Predictors Outcome 



We thank all patients and their close relatives for their benevolent participation.

Compliance with ethical standards


Gidske and Peder Jacob Sørensens’ research foundation provided financial support for the study to be completed. The sponsor had no role in the design or conduct of this research.

Conflict of interest


Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study, their close relatives or legal guardians.


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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Jarle Sundseth
    • 1
    Email author
  • Antje Sundseth
    • 2
    • 3
  • Eva Astrid Jacobsen
    • 4
  • Are Hugo Pripp
    • 5
  • Wilhelm Sorteberg
    • 1
  • Marianne Altmann
    • 3
  • Karl-Fredrik Lindegaard
    • 1
    • 2
  • Jon Berg-Johnsen
    • 1
    • 2
  • Bente Thommessen
    • 3
  1. 1.Department of NeurosurgeryOslo University Hospital RikshospitaletOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of Neurology, Medical DivisionAkershus University HospitalLørenskogNorway
  4. 4.Department of RadiologyOslo University Hospital RikshospitaletOsloNorway
  5. 5.Oslo Centre of Biostatistics and Epidemiology, Research Support ServicesOslo University HospitalOsloNorway

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