Clinical course and surgical management of massive cerebral infarction.
OBJECTIVE
Acute occlusion of the proximal middle cerebral artery (MCA) can lead to rapid development of fatal brain swelling and ischemic strokes. Decompressive surgery, if performed early in this subpopulation of patients, can reduce mortality and result in a favorable outcome. In this article, we describe our surgical approach for treating malignant MCA syndrome and compare it with other management strategies.


METHODS
This is a retrospective review of patients who developed acute occlusion of the proximal MCA and underwent aggressive surgical decompression (large craniectomy, anterior temporal lobectomy, resection of infarcted tissue, and duraplasty). The outcome of this management strategy is compared with the previously published outcomes of hemicraniectomy and dural augmentation.


RESULTS
Twelve patients were included in the study. The group consisted of six men and six women (mean age, 46.8 yr). Nine patients had right MCA stroke, and three had left MCA infarction. The causes of the strokes were cardioembolic, iatrogenic, small-vessel occlusive disease, and others. The interval between infarction and clinical evidence of herniation varied from 24 hours to 10 days. Two patients died, five were independent or had moderate disabilities, and five had severe disability.


CONCLUSIONS
Surgical decompression consisting of a large craniectomy, anterior temporal lobectomy, resection of infarcted tissue, and duraplasty is beneficial to a significant number of patients with massive MCA stroke and clinical signs of herniation.
Robertson
Scott C
SC
Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA.
Lennarson
Peter
P
Hasan
David M
DM
Traynelis
Vincent C
VC
D000328:Adult; D000368:Aged; D038481:Anterior Temporal Lobectomy; D001929:Brain Edema / Q000209:etiology / Q000601:surgery*; D002544:Cerebral Infarction / Q000150:complications / Q000601:surgery*; D003399:Craniotomy; D019299:Decompression, Surgical / Q000379:methods*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome