[Hemicraniectomy for treatment of malignant medial cerebral artery infarction in 3 patients].
In three patients, a 52-year old man, a 54-year old man and a 17-year old woman, sudden neurological signs such as hemiparalysis and hemihypaesthesia developed, with diminished consciousness occurring at a later stage. Imaging revealed total infarction of the area supplied by the right middle cerebral artery with the threat of intracranial hypertension. Once informed consent had been obtained from the patient's representatives, hemicraniectomy with dural augmentation was performed. Although the primary neurological deficit persisted, the three patients assessed their quality of life as valuable with their Barthel scores ranging from 45 to 90. Total infarction of the middle cerebral artery may result in intracranial hypertension and transtentorial herniation owing to the development of cytotoxic oedema, particularly in young patients. The prognosis of this condition is poor partly due to the limited effect of non-surgical treatment. Hemicraniectomy with dural augmentation prevents secondary brain damage caused by the space-occupying effect of the infarct. This operation reduces mortality considerably. The findings in these patients along with the results in the literature warrant a randomised study of the results of hemicraniectomy in patients with malignant middle cerebral artery infarction.
van Leusen
H J
HJ
Afd. Neurologie, Medisch Centrum Haaglanden, locatie Westeinde, Postbus 432, Den Haag.
Tans
J T
JT
Wurzer
J A
JA
D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019586:Intracranial Hypertension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011379:Prognosis; D014057:Tomography, X-Ray Computed