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Clinical course and surgical management of massive cerebral infarction

Scott C Robertson1, Peter Lennarson, David M Hasan

  • 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA.

Neurosurgery
|June 25, 2004
PubMed
Abstract

Insights

Aggressive surgical decompression, including large craniectomy and tissue resection, can improve outcomes for patients with malignant middle cerebral artery (MCA) stroke and brain herniation, reducing mortality and disability.

Area of Science:

  • Neurosurgery
  • Stroke Medicine
  • Neurology

Background:

  • Acute occlusion of the proximal middle cerebral artery (MCA) can rapidly cause fatal brain swelling and ischemic strokes.
  • Early decompressive surgery in select patients with malignant MCA syndrome can reduce mortality and improve outcomes.

Purpose of the Study:

  • To describe a specific surgical approach for malignant MCA syndrome.
  • To compare this aggressive surgical decompression strategy with other management options.

Main Methods:

  • Retrospective review of 12 patients undergoing large craniectomy, anterior temporal lobectomy, infarcted tissue resection, and duraplasty.
  • Comparison of outcomes with previously published data on hemicraniectomy and dural augmentation.

Main Results:

  • The study included 12 patients (6 male, 6 female; mean age 46.8 years).
  • Outcomes included 2 deaths, 5 patients with moderate disability, and 5 with severe disability.
  • The interval from stroke onset to herniation varied significantly.

Conclusions:

  • Aggressive surgical decompression involving large craniectomy, temporal lobectomy, and resection is beneficial for patients with massive MCA stroke and herniation.
  • This approach can lead to favorable outcomes in a significant number of patients.

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