The role of surgery in ischemic stroke: decompressive surgery.
OBJECTIVE
This review gives an integrated view on the current status of decompressive surgery in space-occupying hemispheric brain infarction with a focus on new developments based on the available data of recent clinical trials, also including preliminary data from randomized trials reported at international stroke conferences in 2006.


RESULTS
The treatment of ischemic brain infarction with life-threatening space-occupying edema is, because of a lack of prospective studies, one of the major controversial issues within neurocritical care medicine today. Only a few years ago, massive cerebral infarctions were regarded an untreatable disease with fatal outcome. The introduction of decompressive surgery (hemicraniectomy) has completely changed this point of view. Most of the reports, however, are retrospective with low numbers of patients. There are only few prospective trials that suggest a substantial benefit of decompressive surgery to significantly reduce mortality as compared to maximal conservative treatment alone. The control groups in these studies, however, consist of patients with higher age and higher rates of co-morbidities. Also, in most studies information on long-term outcome is insufficient. In 2006 long expected preliminary data from randomized trials of hemicraniectomy have been reported at international stroke conferences. They yield very positive results.


CONCLUSIONS
Decompressive surgery appears to be a promising treatment option for patients with space-occupying hemispheric brain infarction.
Unterberg
Andreas
A
Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany. andreas.unterberg@med.uni-heidelberg.de
Juettler
Eric
E
D002545:Brain Ischemia / Q000601:surgery*; D019299:Decompression, Surgical; D006801:Humans; D011379:Prognosis; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome