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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Craniectomy for acute ischemic stroke: how to apply the data to the bedside
Amedeo Merenda1, Michael DeGeorgia
1Neurological Institute, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5040, USA.
Current Opinion in Neurology
|December 2, 2009
Summary
Decompressive craniectomy significantly reduces mortality for malignant hemispheric infarction. Early surgery within 48 hours improves outcomes for patients aged 60 or younger.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Malignant hemispheric infarction carries an 80% mortality rate due to increased intracranial pressure and herniation.
- Decompressive craniectomy mitigates these effects by allowing outward brain swelling, potentially reducing mortality to 20%.
Purpose of the Study:
- To review the evidence on the benefits and limitations of decompressive craniectomy in malignant cerebral infarction.
- To assess the impact of decompressive hemicraniectomy on mortality and functional outcomes.
Main Methods:
- Review of evidence from recent European randomized trials.
- Analysis of outcomes in patients undergoing decompressive hemicraniectomy for large hemispheric infarction.
Main Results:
- Decompressive hemicraniectomy is lifesaving for large hemispheric infarction.
- Improved functional outcomes are observed in patients aged 60 or younger treated within 48 hours of stroke onset.
Conclusions:
- Early decompressive hemicraniectomy (within 48 hours) is strongly recommended for malignant hemispheric infarction in patients 60 years or younger.
- Further research is needed to define neuroimaging criteria for intervention and clarify the role of surgery in older patients or when delayed beyond 48 hours.
