title: Decompressive craniectomy for space-occupying supratentorial infarction: rationale, indications, and outcome.
abstract: A subset of patients with ischemic cerebrovascular stroke suffer a progressive deterioration secondary to massive cerebral ischemia, edema, and increased intracranial pressure (ICP). The evolution is often fatal. In these patients, a decompressive craniectomy converts the closed, rigid cranial vault into an "open box." The result is a dramatic decrease in ICP and a reversal of the clinical and radiological signs of herniation. For these reasons, decompressive craniectomy has been increasingly proposed as a life-saving measure in patients with large, space-occupying hemispheric infarction. The authors review the rationale, indications, and clinical experience with this procedure, which has been performed in patients who have had supratentorial ischemic stroke.
authors.affiliation: Department of Neurosurgery, Derriford Hospital, Plymouth, United Kingdom.
authors.forename: D J
authors.initials: DJ
authors.lastname: Lanzino
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D002544:Cerebral Infarction / Q000209:etiology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000473:pathology; D016896:Treatment Outcome