J Cerebrovasc Endovasc Neurosurg.  2013 Jun;15(2):61-66. 10.7461/jcen.2013.15.2.61.

Where are We Now with Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction?

• Park J
• Hwang JH

• KMID: 1980431
• DOI: http://doi.org/10.7461/jcen.2013.15.2.61

Abstract

In spite of the best medical treatment, large hemispheric infarction, resulting from acute occlusion of either the internal carotid or the proximal middle cerebral artery with insufficient collateral blood flow is associated with a high case fatality rate of approximately 60%. Thus, a decompressive hemicraniectomy is considered a life-saving procedure for this devastating disease. Findings of three recent randomized, controlled clinical trials and their meta-analysis showed that early surgical decompression not only reduced the number of case fatalities but also increased the incidence of favorable outcomes. The authors review the pathophysiology, historical background in previous studies, operative timing, surgical technique and clinical outcomes of surgical decompression for malignant hemispheric infarction.

Keyword

Brain edema; Cerebral infarction; Decompressive surgery; Middle cerebral artery

MeSH Terms

Brain Edema
Cerebral Infarction
Decompression, Surgical
Incidence
Infarction
Middle Cerebral Artery

Figure

• 

  Fig. 1 Computed tomography (CT) scans taken before and after decompressive surgery, including a hemicraniectomy with resection of the temporalis muscle and fascia for acute middle cerebral artery (MCA) infarction. (A) Preoperative CT scan taken 20 hours after stroke onset shows an MCA territory infarction with a significant midline brain shift. (B) On postoperative CT scan one day after decompressive surgery, the craniectomy covers the whole MCA territory without any epidural/subgaleal hematoma and completely relieves the midline brain shift. (C) On postoperative CT scan three days after decompressive surgery, the overlying scalp successfully accommodates the aggravated brain swelling.

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