Role of Decompressive Craniectomy in Ischemic Stroke
- 1Universitätsklinikum Carl Gustav Carus, Germany
Ischemic stroke is one of the leading causes for death and disability worldwide. In patients with large space-occupying infarction, the subsequent edema complicated by transtentorial herniation poses a lethal threat. Especially in patients with malignant middle cerebral artery infarction, brain swelling secondary to the vessel occlusion is associated with high mortality. By decompressive craniectomy, a significant proportion of the skull is surgically removed, allowing the ischemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. Several studies have shown that decompressive craniectomy reduces the mortality rate in patients with malignant cerebral artery infarction. However, this is done for the cost of a higher proportion of patients who survive with severe disability. In this review, we will describe the clinical and radiological features of malignant middle cerebral artery infarction and the role of decompressive craniectomy and additional therapies in this condition. We will also discuss large cerebellar stroke and the possibilities of suboccipital craniectomy.
Keywords: Stroke - Diagnosis, therapy, Middle cerebral artery (MCA) occlusion, Posterior circulation stroke, Decompressive Craniectomy, prognosis
Received: 04 Sep 2018;
Accepted: 06 Dec 2018.
Edited by:Stephen Honeybul, Sir Charles Gairdner Hospital, Australia
Reviewed by:Aristeidis H. Katsanos, University of Ioannina, Greece
Syed O. Shah, Jefferson University Hospitals, Thomas Jefferson University, United States
Copyright: © 2018 Pallesen, Barlinn and Puetz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Lars-Peder Pallesen, Universitätsklinikum Carl Gustav Carus, Dresden, Germany, Lars-Peder.pallesen@uniklinikum-Dresden.de