Decompressive Craniectomy for Malignant Middle Cerebral Artery Stroke

Landreneau, Mark M. MD
Sheth, Kevin N. MD

¹Section of Neurocritical Care and Emergency Neurology, Yale University, New Haven, Connecticut
²Department of Neurology, Yale University, New Haven, Connecticut
³Department of Neurosurgery, Yale University, New Haven, Connecticut

Address for correspondence Kevin N. Sheth, MD, Department of Neurology, Yale University, PO Box 208018, New Haven, CT 06520, [email protected]

Seminars in Respiratory & Critical Care Medicine 38(6):p 737-744, December 2017. | DOI: 10.1055/s-0037-1607992

Abstract

Advancements in the treatment of ischemic stroke have led to a recent decline in overall stroke mortality, but patients with hemispheric infarcts remain at high risk for death. Recent advances in the approach to this devastating disease include early identification of patients at high risk for swelling and standardized approaches to medical therapy. However, surgical decompression continues to be the most effective treatment for malignant edema from large hemispheric strokes. Patient selection in the past had been strictly limited to younger ages and the nondominant hemisphere. More recent evidence demonstrates a mortality benefit in older patients with a limited impact on morbidity. Judicious patient selection and shared, informed decision making with families remain the optimal approach for this devastating disease.