Malignant middle cerebral artery infarction is associated with up to 80% mortality due to ischemic edema and brain herniation. No medical therapy has proven its efficacy in efficiently and durably reducing brain edema and improving patients' outcome. Decompressive surgery by a large hemicraniectomy with durotomy has been suggested as a life-saving emergency procedure. However, because of the lack of established prognostic criteria, the fear of severe and "unacceptable" residual disability in surviving patients, and the impossibility of considering the opinion of the patient at the time of decision, there was no consensus regarding this surgery. Recently the results of a pooled analysis of three European randomized trials (DECIMAL, DESTINY, and HAMLET) of early (
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Blood pressure variability and functional outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Eur J Neurol
January 2025
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Background And Purpose: Malignant middle cerebral artery infarction (MMI) is a severe condition with a high mortality rate. While decompressive hemicraniectomy has been demonstrated to reduce mortality, there is limited knowledge regarding blood pressure (BP) management following the surgery. This study aimed to investigate whether early blood pressure variability after surgery is associated with functional outcomes.
View Article and Find Full Text PDFCritical Care Decisions After Large Core Cerebral Infarctions: A Secondary Analysis From the SELECT2 Trial.
Ann Neurol
December 2024
Department of Neurology and Stroke, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
Article Synopsis
- This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
- Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
- About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
Intracranial pressure trends and clinical outcomes after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Ann Intensive Care
November 2024
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Background: Malignant middle cerebral artery infarction (MMI) is associated with a high incidence of severe disability and mortality. Decompressive hemicraniectomy has become a recognized treatment that can improve the prognosis for patients if performed within a certain time window. Nevertheless, despite this intervention, a mortality rate of approximately 20-40% persists following the surgery.
View Article and Find Full Text PDFCranioplasty for Sinking Flap Syndrome in Chronic Subdural Hematoma: A Case Report.
Cureus
October 2024
Department of Neurotraumatology and Spine, SRH Wald-Klinikum Gera, Gera, DEU.
Article Synopsis
- Sinking flap syndrome (SFS) is a rare but serious complication that can occur after a decompressive craniectomy, potentially causing major neurological issues due to pressure changes.
- An 81-year-old man with chronic subdural hematoma experienced SFS after his initial surgeries, which included mini-craniectomy and hemicraniectomy to address severe hematoma problems.
- After undergoing cranioplasty, the patient significantly improved, regaining strength and awareness, and imaging showed no new bleeding and stable intracranial conditions.
Risk score for early prognostication of aseptic bone flap necrosis.
Acta Neurochir (Wien)
November 2024
Department of Neurosurgery and Spine Surgery, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
Purpose: Aseptic bone flap necrosis (ABFN) is a common complication of autologous cranioplasty that often requires reoperation. This study aimed to create a risk score for ABFN using relevant demographic, clinical, and laboratory markers.
Methods: We included all patients who underwent autologous cranioplasty after decompressive surgery between 2007 and 2019.
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