Introduction: Malignant MCA infarct is a common cause of morbidity and mortality. Decompressive hemicraniectomy (DC) is a well-established mode of treating malignant MCA infarct. This article shares our experience with an insight into the problems faced and the lessons learnt in the process. Materials And Methods: Patients with Malignant MCA Infarct and subjected to decompressive hemicraniectomy at the Institute of Neurosurgery, Madras Medical College, Chennai, from January 2017 to January 2018 were included. Outcome was assessed in terms of mortality and modified Rankin scale (mRS). Results: A total of 28 patients underwent DC for malignant MCA infarct between January 2017 and January 2018 at our institute. The mean age of the study group was 47.1±13.73yr. Seventeen patients (60.7%) had left MCA territory infarct while 11 patients (39.3%) had right MCA territory infarct. 18% of patients had an mRS of 0-3 at discharge and 7% had mRS of 4 and more. Approximately, 20% of patients operated within 24 h had mRS 0–3 at discharge while only 12.5% patients operated after 48 h had mRS 0–3 at discharge. Conclusion: A subset of patients survives but remains in bedridden state. Mortality and functional outcome can be better with early access and prompt intervention. Interval between clinical deterioration and surgery is more relevant than early surgery in determining the outcome. Although age is an impediment to favourable outcome, deserving candidates should not be denied surgery because of age.

Keywords: Malignant Middle Cerebral Artery Infarct; Neurological Outcome; Morbidity; Decompressive Hemicraniectomy; Mrs.