Korean J Cerebrovasc Surg.  2009 Jun;11(2):49-54.

Decompressive Craniectomy for Malignant Middle Cerebral Infarction

• Hwang G
• Oh CW
• Han JH
• Kim CY
• Kwon OK
• Park SQ
• Han MK
• Bae HJ

Abstract

Decompressive craniectomy is used to treat increased intracranial pressure due to brain swelling in middle cerebral artery infarction. Recently, 3 European multicenter, prospective, randomized trials and a pooled analysis were published. In the pooled analysis, decompressive craniectomy did not appear to increase the risk of complete dependency, misery, and hopelessness. Exactly 2 patients in the surgical and medical groups (5%) were bedbound and severely disabled (mRS 5) at 1 year. The proportion of patients alive with minimal-tomoderate disability (mRS 0-3), however, was significantly increased from 21% to 43%. Decompressive craniectomy resulted in a 49% absolute risk reduction in death, and an absolute increase in the proportion of patients rated as mRS 2 of 12%, mRS 3 of 10%, and mRS 4 of 29%. But, this can be applied in cases with relative young age and early surgical procedure. Therefore, the indication for decompressive craniectomy should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.

Keyword

Decompressive craniectomy; Malignant middle cerebral artery infarction; Intracranial hypertension

MeSH Terms

Brain Edema
Caregivers
Cerebral Infarction
Decompressive Craniectomy
Dependency (Psychology)
Humans
Infarction, Middle Cerebral Artery
Intracranial Hypertension
Intracranial Pressure
Numbers Needed To Treat