Craniectomy for acute ischemic stroke: How to apply the data to the bedside

Amedeo Merenda, Michael Degeorgia

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Malignant hemispheric infarction is associated with a high mortality rate, approximately 80%, as a result of the development of intracranial pressure gradients, brain tissue shift, and herniation. By allowing the brain to swell outwards and equalizing pressure gradients, decompressive craniectomy appears to significantly reduce the mortality to approximately 20%. This review takes a comprehensive look at the evidence highlighting the benefits and limits of decompressive craniectomy in malignant cerebral infarction. RECENT FINDINGS: Three recent European randomized trials have provided compelling evidence that decompressive hemicraniectomy for large hemispheric infarction is not only lifesaving, but also leads to improved functional outcome in patients 60 years of age or less when treated within 48 h of stroke onset. SUMMARY: Early decompressive hemicraniectomy (≤48 h) should be strongly considered in any patient 60 years old or less presenting with malignant hemispheric infarction. Further studies are needed to establish objective neuroimaging criteria for aggressive intervention, and to clarify the role of decompressive surgery in older patients (>60 years old) and perhaps, when delayed beyond 48 h.

Original languageEnglish
Pages (from-to)53-58
Number of pages6
JournalCurrent Opinion in Neurology
Volume23
Issue number1
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

Fingerprint

Decompressive Craniectomy
Infarction
Stroke
Mortality
Cerebral Infarction
Intracranial Pressure
Brain
Neuroimaging
Pressure

Keywords

  • Decompressive hemicraniectomy
  • Ischemic stroke
  • Malignant hemispheric infarction
  • Neurocritical care

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Craniectomy for acute ischemic stroke : How to apply the data to the bedside. / Merenda, Amedeo; Degeorgia, Michael.

In: Current Opinion in Neurology, Vol. 23, No. 1, 01.02.2010, p. 53-58.

Research output: Contribution to journalArticle

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