Hemicraniectomy for Ischemic and Hemorrhagic Stroke: Facts and Controversies

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Malignant large artery stroke carries a high mortality rate (70-80%) even with optimal medical care.
• Decompressive craniectomy (DC) is a recognized intervention for reducing mortality in severe stroke.
• Growing evidence supports DC's efficacy in improving survival and functional outcomes.

Purpose of the Study:

• To comprehensively review the evidence supporting decompressive craniectomy (DC) for malignant stroke.
• To discuss patient selection criteria and nuances for DC.
• To explore the applicability of DC in specific stroke types, including supratentorial and posterior fossa strokes.

Main Methods:

• Review of randomized controlled trials and retrospective studies on decompressive craniectomy.
• Analysis of evidence regarding survival benefits and functional outcomes.
• Examination of patient selection criteria and stroke subtype applicability.

Main Results:

• Decompressive craniectomy (DC) demonstrates significant survival benefits in appropriately selected patients with malignant stroke.
• Evidence supports improved functional outcomes in addition to mortality reduction with DC.
• DC is applicable to both supratentorial intracerebral hemorrhage and posterior fossa strokes.

Conclusions:

• Decompressive craniectomy is a crucial treatment option for malignant large artery stroke.
• Careful patient selection is paramount for optimizing outcomes with DC.
• The evidence base for DC continues to expand, reinforcing its role in neurocritical care.