Decompressive hemicraniectomy for malignant middle cerebral artery infarction: an update.
BACKGROUND
Malignant middle cerebral artery (MCA) infarction is a devastating disease affecting a minority of stroke victims. The mortality rate from malignant MCA infarction managed with conservative medical treatment is estimated at 80%. Standard medical management includes physiologic support, osmotherapy, intubation and mechanical ventilation, and intracranial pressure monitoring. Decompressive hemicraniectomy has been viewed with skepticism because of lack of evidence from randomized controlled trials.


METHODS
Narrative review of recent surgical evidence in favor of hemicraniectomy.


RESULTS
Current evidence from randomized controlled trials and a recent pooled analysis, show clear benefit from hemicraniectomy with improved survival and better functional outcomes.


CONCLUSIONS
Hemicraniectomy for malignant MCA infarction is a life saving procedure. Further data on quality of life outcomes and patient and caregiver burden are required. Until that time, selection of patients for hemicraniectomy still requires an individual approach.
Subramaniam
Suresh
S
Department of Clinical Neurosciences, Medicine, Community Health Sciences, University of Calgary, Alberta, Canada.
Hill
Michael D
MD
D000367:Age Factors; D001929:Brain Edema / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D002341:Carotid Artery Thrombosis / Q000150:complications; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003399:Craniotomy / Q000379:methods* / Q000592:standards; D019299:Decompression, Surgical / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D012886:Skull / Q000033:anatomy & histology / Q000601:surgery