Suresh Subramaniam1, Michael D Hill. 1. Department of Clinical Neurosciences, Medicine, Community Health Sciences, University of Calgary, Alberta, Canada.
Abstract
BACKGROUND: Malignant middle cerebral artery (MCA) infarction is a devastating disease affecting a minority of stroke victims. The mortality rate from malignant MCA infarction managed with conservative medical treatment is estimated at 80%. Standard medical management includes physiologic support, osmotherapy, intubation and mechanical ventilation, and intracranial pressure monitoring. Decompressive hemicraniectomy has been viewed with skepticism because of lack of evidence from randomized controlled trials. METHODS: Narrative review of recent surgical evidence in favor of hemicraniectomy. RESULTS: Current evidence from randomized controlled trials and a recent pooled analysis, show clear benefit from hemicraniectomy with improved survival and better functional outcomes. DISCUSSION: Hemicraniectomy for malignant MCA infarction is a life saving procedure. Further data on quality of life outcomes and patient and caregiver burden are required. Until that time, selection of patients for hemicraniectomy still requires an individual approach.
BACKGROUND:Malignant middle cerebral artery (MCA) infarction is a devastating disease affecting a minority of stroke victims. The mortality rate from malignant MCA infarction managed with conservative medical treatment is estimated at 80%. Standard medical management includes physiologic support, osmotherapy, intubation and mechanical ventilation, and intracranial pressure monitoring. Decompressive hemicraniectomy has been viewed with skepticism because of lack of evidence from randomized controlled trials. METHODS: Narrative review of recent surgical evidence in favor of hemicraniectomy. RESULTS: Current evidence from randomized controlled trials and a recent pooled analysis, show clear benefit from hemicraniectomy with improved survival and better functional outcomes. DISCUSSION: Hemicraniectomy for malignant MCA infarction is a life saving procedure. Further data on quality of life outcomes and patient and caregiver burden are required. Until that time, selection of patients for hemicraniectomy still requires an individual approach.
Authors: Serkan Kitiş; Serdar Çevik; Kevser B Köse; Arzu Baygül; Serhat Cömert; Ülkün Ü Ünsal; Meliha G Papaker Journal: Ann Indian Acad Neurol Date: 2020-12-01 Impact factor: 1.383
Authors: Bilal Kamal Alam; Ahmed S Bukhari; Salman Assad; Pir Muhammad Siddique; Haider Ghazanfar; Muhammad Junaid Niaz; Maryam Kundi; Saima Shah; Maimoona Siddiqui Journal: Cureus Date: 2017-01-26