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[Decompression craniectomy--life-saving treatment in acute cerebral infarction]
S Sollid1, R Kloster, T Ingebrigtsen
1Nevrokirurgisk avdeling Regionsykehuset i Tromsø.
Summary
Decompressive hemicraniectomy can save lives following massive cerebral infarction. This procedure normalizes intracranial pressure, preventing herniation and allowing patients to survive with improved functional outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Massive cerebral infarction frequently leads to fatal transtentorial herniation.
- Decompressive hemicraniectomy is a proposed intervention to mitigate mortality.
Observation:
- A 61-year-old male presented with a right middle cerebral artery infarction, initially conscious with left hemiplegia.
- Consciousness declined to a Glasgow Coma Scale score of 5, with intracranial pressure (ICP) rising to 40 mm Hg.
- Surgical intervention included a right-sided decompressive hemicraniectomy.
Findings:
- The decompressive hemicraniectomy immediately normalized elevated ICP.
- Post-surgery, the patient survived and was discharged home with minimal assistance.
- Ten months post-procedure, the patient exhibited moderate left leg paresis and a paralytic left arm, but could ambulate.
Implications:
- Decompressive hemicraniectomy is a viable, life-saving procedure for massive cerebral infarction.
- Early surgical intervention can prevent death and reduce the severity of disability.
- This case highlights the potential for significant functional recovery after hemicraniectomy.