Craniectomy for acute ischemic stroke: how to apply the data to the bedside

Current Opinion in Neurology
Amedeo Merenda, Michael DeGeorgia

Abstract

Malignant hemispheric infarction is associated with a high mortality rate, approximately 80%, as a result of the development of intracranial pressure gradients, brain tissue shift, and herniation. By allowing the brain to swell outwards and equalizing pressure gradients, decompressive craniectomy appears to significantly reduce the mortality to approximately 20%. This review takes a comprehensive look at the evidence highlighting the benefits and limits of decompressive craniectomy in malignant cerebral infarction. Three recent European randomized trials have provided compelling evidence that decompressive hemicraniectomy for large hemispheric infarction is not only lifesaving, but also leads to improved functional outcome in patients 60 years of age or less when treated within 48 h of stroke onset. Early decompressive hemicraniectomy (<or=48 h) should be strongly considered in any patient 60 years old or less presenting with malignant hemispheric infarction. Further studies are needed to establish objective neuroimaging criteria for aggressive intervention, and to clarify the role of decompressive surgery in older patients (>60 years old) and perhaps, when delayed beyond 48 h.

References

Jul 1, 1992·Stroke; a Journal of Cerebral Circulation·R C Heros
Jul 1, 1992·Stroke; a Journal of Cerebral Circulation·H J ChenC P Wei
Jun 1, 1990·Stroke; a Journal of Cerebral Circulation·J B DelashawM S Grady
Oct 1, 1987·Journal of Neurosurgery·S Hatashita, J T Hoff
Jan 1, 1986·Acta neurochirurgica·L M AuerI Sayama
May 1, 1974·Stroke; a Journal of Cerebral Circulation·H S IvamotoR M Donaghy
Jan 1, 1982·Stroke; a Journal of Cerebral Circulation·R C Heros
Sep 1, 1995·Journal of Neurology, Neurosurgery, and Psychiatry·P MathewD Oluoch-Olunya
Feb 1, 1995·Stroke; a Journal of Cerebral Circulation·M ForstingK Sartor
Sep 1, 1994·Stroke; a Journal of Cerebral Circulation·N A SolomonK A Schulman
Feb 1, 1994·Stroke; a Journal of Cerebral Circulation·C R HornigA Laun
Sep 10, 1998·Stroke; a Journal of Cerebral Circulation·S SchwabW Hacke
Feb 5, 1999·Stroke; a Journal of Cerebral Circulation·D W KriegerL Hantson
Sep 8, 2000·Stroke; a Journal of Cerebral Circulation·C OppenheimC Marsault
Oct 21, 2000·Progress in Neurobiology·G Kerkhoff
Feb 13, 2001·Journal of Neurology, Neurosurgery, and Psychiatry·M HoltkampF Masuhr
Sep 8, 2001·Stroke; a Journal of Cerebral Circulation·S E KasnerD W Krieger
Sep 21, 2002·Journal of Neurology·Birgit WalzRoman L Haberl
May 20, 2003·Journal of Neurology, Neurosurgery, and Psychiatry·M B PraneshA Pehlaj
Oct 29, 2003·Neurosurgery·Antonino RacoMaurizio Salvati
Jan 7, 2004·Stroke; a Journal of Cerebral Circulation·Rishi GuptaMitchell S V Elkind
Feb 12, 2005·Stroke; a Journal of Cerebral Circulation·Frank KastrauFrank Block
Sep 21, 2005·Acta neurochirurgica·S HarscherO W Witte
Jul 13, 2006·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·K-W WangC-H Lu
Feb 6, 2007·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Chun-Chung ChenShu-Chiu Tsai
Feb 17, 2007·Lancet Neurology·Katayoun VahediUNKNOWN DECIMAL, DESTINY, and HAMLET investigators
Aug 11, 2007·Stroke; a Journal of Cerebral Circulation·Eric JüttlerUNKNOWN DESTINY Study Group
Jan 24, 2008·Cerebrovascular Diseases·Jeannette HofmeijerH Bart van der Worp
Jul 4, 2009·Stroke; a Journal of Cerebral Circulation·Eric JüttlerAlfred Aschoff
Jul 4, 2009·Stroke; a Journal of Cerebral Circulation·Thomas PfefferkornStefan Grau

❮ Previous
Next ❯

Citations

Mar 2, 2011·Current Treatment Options in Cardiovascular Medicine·David Z WangArun V Talkad
Dec 31, 2010·Current Treatment Options in Neurology·J Marc SimardBrian P Walcott
Feb 15, 2014·BioMed Research International·Gabriele RonchettiMarco Maria Fontanella
Jul 8, 2011·Acta Neurologica Scandinavica. Supplementum·E FarbuM W Kurz
Dec 21, 2010·Developmental Medicine and Child Neurology·Robert C Tasker
Nov 5, 2010·Current Opinion in Supportive and Palliative Care

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.

Acute Stroke

A stroke occurs when blood supply to the brain is interrupted depriving the brain of oxygen and nutrients. This feed focuses cerebrovascular accidents including ischemic and paralytic stroke.