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Updated: Aug 7, 2026
Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
[External ventricular drainage in complete infarction of the medial cerebral artery]
Y Aladro1, C Muñoz-Fernández, M J Alemany-Rodríguez
1Servicio de Neurología, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España. yalaben@gobiernodecanarias.org
Insights
External ventriculostomy rapidly improved a patient with malignant hemispheric infarction and herniation. This intervention, reducing intracranial pressure, may be lifesaving, warranting further study.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Massive hemispheric infarction causes increased intracranial pressure (ICP) unresponsive to medical management.
- Transtentorial herniation and mortality are common complications of malignant middle cerebral artery infarction.
- Decompressive hemicraniectomy is a reported treatment, but the efficacy of external ventriculostomy for ICP reduction remains unclear.
Observation:
- A 33-year-old female with right middle cerebral artery infarction experienced transtentorial herniation and left lateral ventricular dilation.
- The patient showed rapid clinical improvement following external ventriculostomy, without undergoing hemicraniectomy.
- Brain tissue partial oxygen pressure (PtiO2) was monitored and correlated with clinical status.
Findings:
- External ventriculostomy effectively reduced intracranial pressure in this case of malignant hemispheric infarction.
- PtiO2 monitoring demonstrated a correlation with clinical events, aiding therapeutic decision-making.
- The patient's rapid improvement suggests external ventriculostomy as a viable alternative to hemicraniectomy.
Implications:
- External ventricular drainage may be a lifesaving intervention for select patients with malignant hemispheric infarction.
- Further research is needed to establish the role and efficacy of external ventriculostomy in this critical condition.
- PtiO2 monitoring can be a valuable tool for guiding treatment strategies in these complex neurological cases.
Introduction:
Increased intracranial pressure (ICP) due to complete middle cerebral artery territory infarction does not respond to medical treatment and is often followed by transtentorial herniation and death. Some authors have reported good outcome after performing decompressive hemicraniectomy in this condition. The potential clinical benefit of intracranial pressure reduction by means of an external ventriculostomy in such cases is unknown.
Case Report:
The present paper discusses the case of a 33 year old female who suffered a massive infarction of the territory of the right middle cerebral artery with transtentorial herniation and left lateral ventricular dilation who rapidly improved after performing external ventriculostomy without hemicraniectomy. The brain tissue partial oxygen pressure (PtiO2) was monitored in the left frontal lobe and a fair correlation with clinical events was found.
Conclusions:
External ventricular drainage without hemicraniectomy could be lifesaving in some case of massive ( malignant ) hemispheric infarction and more studies on this therapeutic approach would be needed. Monitoring PtiO2 in these patients would be useful in adopting therapeutic decisions.
