Stroke, Vol 21, 874-881, Copyright © 1990 by American Heart Association
JB Delashaw, WC Broaddus, NF Kassell, EC Haley, GA Pendleton, DG Vollmer, WW Maggio and MS Grady
An anecdotal series of nine patients (three men and six women with an
average age of 57 years) presented with progressive neurologic
deterioration while on medical therapy for large right hemispheric cerebral
infarction. Clinical signs of uncal herniation (anisocoria or fixed and
dilated pupils, and/or left hemiplegia with right decerebrate posturing)
were present in seven of these nine patients. Computerized tomography of
the head confirmed mass effect from cerebral edema. It was the clinical
judgment of the treating neurologists and neurosurgeons that each of these
nine patients would perish unless surgical decompression of the infarcted
brain was performed. Accordingly, each was treated with right
hemicraniectomy and dural augmentation. Six patients demonstrated
neurologic improvement on the first postoperative day. One patient, with a
postoperative diagnosis of lung cancer, died 1 month after surgery. The
remaining eight patients are currently living with their families with a
follow-up period ranging from 5 to 25 months. Patient outcome as evaluated
by the Barthel Index indicates that three individuals are functioning with
minimal assistance and that the remaining six patients are functionally
dependent. After rehabilitative therapy, four patients returned for
elective cranioplasty. These results suggest that hemicraniectomy can be an
effective lifesaving procedure for malignant cerebral edema after large
hemispheric infarction.
ARTICLES
Treatment of right hemispheric cerebral infarction by hemicraniectomy
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville 22908.
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