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(Stroke. 2007;38:2410.)
© 2007 American Heart Association, Inc.

Editorials

Hemicraniectomy

A Second Chance on Life for Patients With Space-Occupying MCA Infarction

Stephan A. Mayer, MD, FCCM

From the Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, New York, NY.

Correspondence to Stephan A. Mayer, MD, Neurological Institute, 710 West 168th Street, Box 39, New York, NY 10032. E-mail sam14@columbia.edu

Key Words: decompressive surgery • MCA infarction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related articles, pages 2506–2517 and 2518–2525.

So-called "malignant" middle cerebral artery (MCA) territory infarction is the most devastating form of ischemic stroke. With conventional medical therapy, including endotracheal intubation, blood pressure control, osmotherapy, hyperventilation, and barbiturate anesthesia for refractory intracranial hypertension, mortality rates of up to 80% have been reported.^1–3 Death or neurological devastation results from progressive swelling of the infarct, brain tissue shifts, compartmentalized elevation of intracranial pressure, and the extention of ischemia to adjoining vascular territories.

Decompressive hemicraniectomy and duroplasty for malignant MCA territory infarction is intended to prevent the death spiral by normalizing intracranial pressure, restoring compromised flow in the penumbra and adjacent vascular territories, and restoring the midline position of the brain stem and diecephalon. The procedure is not new, but was performed rarely for MCA infarction before the 1990s, primarily because of concerns that it would result in survival with overwhelming neurological impairment and handicap. With improvements in postoperative critical care, however, there has been a resurgence of interest in hemicraniectomy over the past 10 years. Several case series and nonrandomized case-control studies have suggested that hemicraniectomy can improve survival,^4,5 but the evidence has been far from definitive, particularly regarding the extent of residual handicap in those who survive the procedure. Given the lack of evidence from clinical trials to date, hemicraniectomy has remained one of the most controversial and hotly debated topics in stroke care. Is it "radical surgery" that only leads to more pain and suffering, or a beneficial procedure that . . . [Full Text of this Article]

Related Article:

Sequential-Design, Multicenter, Randomized, Controlled Trial of Early Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction (DECIMAL Trial)

Katayoun Vahedi, Eric Vicaut, Joaquim Mateo, Annie Kurtz, Mikael Orabi, Jean-Pierre Guichard, Carole Boutron, Gregory Couvreur, François Rouanet, Emmanuel Touzé, Benoît Guillon, Alexandre Carpentier, Alain Yelnik, Bernard George, Didier Payen, Marie-Germaine Bousser on behalf of the DECIMAL Investigators
Stroke 2007 38: 2506-2517. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				S. A. Mayer and S. Schwab Advances in Critical Care and Emergency Medicine 2007 Stroke, February 1, 2008; 39(2): 261 - 263. [Full Text] [PDF]