Malignant cerebral edema after large hemispheric infarct is a highly morbid condition, and major, randomized trials over the last 2 decades have affirmed the beneficial effect of surgical intervention in the form of decompressive craniectomy. Early (<48 hours) decompressive craniectomy increases good functional outcomes (mRS 0-3) and reduces mortality. Additionally, trials have found the benefit of surgery to persist in those patients more than 60 years, though the apparent benefit is of lesser magnitude. A summary table of the major randomized trials of decompressive craniectomy is included. A detailed description and figures of the decompressive craniectomy procedure is included. The complications of decompressive craniectomy are also discussed, and recent literature on promising alternatives, both surgical and medical, is reviewed.
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Hemispheric asymmetry and its influence on cranioplasty complications after decompressive craniectomy.
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Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
To explore temporal dynamics of cerebral herniation through the calvarial defect after decompressive craniectomy. To investigate patterns of hemispheric asymmetry in ischemic stroke and traumatic brain injury after decompressive craniectomy.To assess clinical implications of hemispheric asymmetry evaluation in order to minimize cranioplasty complications.
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Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia.
Objective: The goal of a decompressive craniectomy (DC) or a hinge craniotomy (HC), is to treat intracranial hypertension and reduce mortality. Traditionally, the decompression procedure has been performed with cranial bone removal. However, decompression and repositioning the cranial bone, named HC, has been presented as an alternative for certain cases.
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Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Objective: This randomized controlled trial (RCT) aimed to compare the short-, mid-, and long-term outcomes in patients with malignant intracranial hypertension undergoing either decompressive craniectomy (DC) or hinge craniotomy (HC).
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