Hemicraniectomy For Malignant Infarction Research Articles

Subcortical Sparing Associated with Ambulatory Independence after Hemicraniectomy for Malignant Infarction

Decompressive hemicraniectomy (DHC) is a life-saving 1 Vahedi K. Hofmeijer J. Juettler E. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007; 6: 215-222 Abstract Full Text Full Text PDF PubMed Scopus (1209) Google Scholar and function-sparing 2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar procedure for patients with malignant middle cerebral artery (MCA) infarction. Pooled estimates suggest that approximately 40% of patients achieve ambulatory independence after DHC, 1 Vahedi K. Hofmeijer J. Juettler E. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007; 6: 215-222 Abstract Full Text Full Text PDF PubMed Scopus (1209) Google Scholar ,2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar with age 3 Juttler E. Unterberg A. Woitzik J. et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014; 370: 1091-1100 Crossref PubMed Scopus (360) Google Scholar being the only clinical or radiologic feature found to influence the likelihood of achieving this outcome. 2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar Subcortical infarctions have been shown to impair motor recovery and gait, 4 Jones P.S. Pomeroy V.M. Wang J. et al. Does stroke location predict walk speed response to gait rehabilitation?. Hum Brain Mapp. 2016; 37: 689-703 Crossref PubMed Scopus (36) Google Scholar ,5 Zhu L.L. Lindenberg R. Alexander M.P. Schlaug G. Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke. 2010; 41: 910-915 Crossref PubMed Scopus (194) Google Scholar but whether the presence of a subcortical infarction affects functional outcome following DHC remains unknown. Our aim was to determine if subcortical involvement in malignant MCA infarction is associated with independent ambulation one year following DHC.

Decompressive Surgery for Severe Brain Edema

Decompressive surgery has since long been a promising therapeutic approach for patients with acute severe brain injury at risk to develop severe brain edema. The underlying rationale of removing part of the cranium is to create space for the expanding brain to prevent secondary damage to vital brain tissue. However, until recently, randomized controlled trials that demonstrate the efficacy of decompressive surgery or benefit for outcome were missing. This has changed since the results of 3 randomized trials on hemicraniectomy in malignant infarction of the middle cerebral artery have been published in 2007. In this article, the current evidence for decompressive surgery in the treatment of cerebral ischemia, intracranial hemorrhage, traumatic brain injury, inflammatory diseases, or severe metabolic derangements is reviewed. Although there is increasing evidence for the efficacy of decompressive surgery in reducing intracranial pressure and even mortality, a critical point remains the definition of good or acceptable outcome.