title: Decompressive hemicraniectomy after malignant middle cerebral artery infarction: rationale and controversies.
abstract: Malignant middle cerebral artery stroke carries a very poor prognosis. Significant retrospective data support the hypothesis that decompressive hemicraniectomy decreases mortality rates due to this disease entity. Recently, 3 randomized controlled studies have been published and shed light on these issues and enhance the quality of evidence revolving around this procedure. In this review, the rationale, risks, benefits, and unanswered questions related to hemicraniectomy for acute ischemic stroke are reviewed with an emphasis on how 3 randomized trials have influenced knowledge on this life-saving yet controversial procedure. Further randomized studies are needed to clarify lingering questions regarding age indications and impact on quality of life.
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Arnaout
authors.forename: Salah G
authors.initials: SG
authors.lastname: Aoun
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D001929:Brain Edema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002986:Clinical Trials as Topic; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000601:surgery*; D019586:Intracranial Hypertension / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods