Hemicraniectomy for malignant middle cerebral artery infarction: Current status and future directions

Hemicraniectomy for malignant middle cerebral artery infarction: Current status and future directions

Keywords:

  • decompressive surgery;
  • hemicraniectomy;
  • malignant;
  • middle cerebral artery infarction;
  • space-occupying
Malignant middle cerebral artery infarction is a life-threatening sub-type of ischemic stroke that may only be survived at the expense of permanent disability. Decompressive hemicraniectomy is an effective surgical therapy to reduce mortality and improve functional outcome without promoting most severe disability. Evidence derives from three European randomized controlled trials in patients up to 60 years. The recently finished DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY – II trial gives now high-level evidence for the effectiveness of decompressive hemicraniectomy in patients older than 60 years. Nevertheless, pressing issues persist that need to be answered in future clinical trials, e.g. the acceptable degree of disability in survivors of malignant middle cerebral artery infarction, the importance of aphasia, and the best timing for decompressive hemicraniectomy. This review provides an overview of the current diagnosis and treatment of malignant middle cerebral artery infarction with a focus on decompressive hemicraniectomy and outlines future perspectives.

Hemicraniectomy for malignant middle cerebral artery infarction: Current status and future directions Reviewed by Carmen Lahiff-Jenkins on Wednesday, April 16, 2014 Rating: 5

1 comment:

  1. Ccan you address the 5 known causes of the neuronal cascade of death and what is being done to solve them? Or maybe you know it as Delayed Ischemic Neurological Injury/Deficits
    1. Excitotoxicity
    2. Glutamate poisoning
    3. Pericytes strangling capillaries
    4. Inflammatory action leaking through the blood brain barrier.
    5. Lysosomal Membrane Permeabilization as a Key Player in Brain Ischemic Cell Death.
    I'm just a simple stroke survivor that wants these solved before my next stroke.

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