Abstract
Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death.MethodThe surgical technique of performance of decompressive hemicraniectomy involves removal of an extensive bone flap in the fronto-temporo-parieto-occipital zone with resection of the temporal squama and of the greater wing of the sphenoid bone to visualize the level of entrance of the middle meningeal artery to the cranial cavity, which, in its turn, allows resection of the upright margin of the middle cranial fossa. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy.ConclusionPerformance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period.
Highlights
Decompressive hemicraniectomy is the most effective method of surgical treatment of malignant ischemic stroke in the territory of the middle cerebral artery (MCA) [2–4, 7]
Decompressive hemicraniectomy consists in resection of an extensive bone flap with a size of least 12 × 12 cm on the side of the affected brain hemisphere, in order to create additional space for the massive postischemic swelling of the brain hemisphere [1]
In cases of malignant ischemic infarction in the MCA territory, conventional decompressive hemicraniectomy does not prevent a severe course of the disease and is associated with a high lethality rate [5, 6]
Summary
Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy. Conclusion Performance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period. Keywords Malignant ischemic infarction · Middle cerebral artery · Decompressive hemicraniectomy · Cerebral edema · Cerebellar tentorium
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