Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

Area of Science:

• Neurology
• Neurosurgery
• Infectious Diseases

Background:

• SARS-CoV2 infection is linked to a prothrombotic state, increasing the risk of malignant cerebral strokes.
• Malignant cerebral strokes in COVID-19 patients present unique challenges due to patient baseline conditions and disease severity.
• Decompressive craniectomy is a critical intervention for malignant cerebral strokes, but its application in COVID-19 patients requires clarification.

Observation:

• A case of a 39-year-old female with mild COVID-19 and no significant cerebrovascular risk factors who experienced a left hemispheric stroke.
• The patient underwent endovascular treatment and subsequently decompressive craniectomy due to neurological deterioration.
• Literature review identified seven prior cases of decompressive craniectomy for COVID-19 associated malignant cerebral strokes.

Findings:

• Eight patients, including the presented case, underwent surgical management for malignant cerebral strokes.
• Six of the eight patients met established stroke guidelines for decompressive craniectomy.
• The mortality rate was 33%, comparable to non-COVID-19 malignant stroke cases, with two left middle cerebral artery stroke patients surviving.

Implications:

• Decompressive craniectomy, guided by current stroke guidelines, is a viable and potentially life-saving treatment for malignant cerebral strokes in COVID-19 patients.
• The findings support the use of established surgical criteria for COVID-19-related malignant cerebral strokes.
• Further research may refine eligibility and management protocols for this patient population.