title: Decompressive hemicraniectomy in a 2-year-old girl with a left middle cerebral artery infarct.
abstract: BACKGROUND
  We report on the case of a 2-year 5-month-old girl with congenital heart disease who developed left middle cerebral artery occlusion and cerebral hemorrhagic infarction a day after ventricular septal defect patch closure.
  
  
  RESULTS
  Cranial computed tomography scan revealed an acute hemorrhagic infarct over the left middle cerebral artery territory with midline shift to the right. Since medical treatment failed, decompressive hemicraniectomy with duraplasty was performed, successfully reversing herniation. Decompressive surgery allows extracranial expansion of the swollen brain and relieves CSF space compression. We believe this to be the youngest reported patient to undergo decompressive hemicraniectomy for middle cerebral artery territory infarction. Although the patient survived, her functional outcome was poor.
  
  
  CONCLUSIONS
  Decompressive hemicraniectomy can be lifesaving and should be considered as an alternative therapy for patients with brain swelling refractory to medical management.
authors.affiliation: Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, Manila, 1000, Philippines. marlmd@yahoo.com
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Tan
authors.forename: Aida M
authors.initials: AM
authors.lastname: Salonga
authors.forename: Roland Dominic G
authors.initials: RD
authors.lastname: Jamora
mesh_terms: D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed