Decompressive craniectomy vs Medical treatment for middle cerebral artery infarction. Decision making in neuroscience professionals and their relatives as patients

Abstract

Introduction: Whether to perform a lifesaving procedure or not, could be different if the prognostic value is known. A malignant stroke in the Medial Cerebral Artery (MCA) has a mortality rate of 80%. A decompressive craniectomy in the first 48 hours could reduce the mortality from 71% to 22%, unfortunately, the survivors will have severe sequels with an important neurologic deficit.
Objective: To know if an informed decision on a procedure could be other knowing the prognosis.
Methods: We performed a prospective study. A total of 51 surveys were made to medical professionals at INNNMVS, in a period of 2 months. The surveys determined if the medical professionals would consent to undergo a decompressive craniectomy to themselves and or a family member.
Results: A total of 72.5% of the specialists surveyed would consent a procedure to a family member if the non-dominant hemisphere is affected, a 58.8% of the surveys said they would consent for the procedure. In another hand, 35.3% would accept to have a family member undergo the procedure if the dominant hemisphere was affected and only 27.5% on themselves. This with the known prognosis after the procedure with a severe neurological deficit.
Conclusion: Knowing the level of disability and the quality of life associated to the procedure, a big part of the medical professionals would not consent to undergo such procedure themselves or their family members this if the dominant hemisphere is affected.