Korean J Cerebrovasc Dis.  2001 Sep;3(2):119-126.

Surgical Management of Acute Infarction

• Kim GK

Abstract

About 15% of the patients with the middle cerebral artery or internal carotid artery territory acute infarction can lead to massive cerebral edema with raised intracranial pressure and progression to coma or death within 3-5 days of the original ictus. Decompressive wide unilateral frontotemporoparietooccipital craniectomy with duroplasty should be given in appropriate time if patient had no effect in combating transtentorial herniation with medical therapy such as mannitol and hyperventilation. Occlusion of posterior inferior cerebellar artery or vertebral artery and superior cerebellar artery can evolve into life-threatening brainstem compression or hydrocephalus from postinfarct cerebellar edema. Suboccipital decompressive craniectomy with resection of necrotic cerebellar tissue or extraventricular drainage may be an effective lifesaving procedure in case of no improvement with medical therapy. Very few cases of acute infarction with embolic occlusion of main trunk of middle cerebral artery which confirmed by angiography within 6-8 hours after onset may be considered to have embolectomy by open craniotomy.

Keyword

Massive brain edema due to infarction; Acute cerebral infarction; Acute cerebeller infarction; Embolectomy; Hemicraniectomy; Suboccipital decompressive craniectomy

MeSH Terms

Angiography
Arteries
Brain Edema
Brain Stem
Carotid Artery, Internal
Coma
Craniotomy
Decompressive Craniectomy
Drainage
Edema
Embolectomy
Humans
Hydrocephalus
Hyperventilation
Infarction*
Intracranial Pressure
Mannitol
Middle Cerebral Artery
Vertebral Artery
Mannitol