Decompressive Craniectomy for Stroke: Who, When, and How - 22/04/22

Doi : 10.1016/j.ncl.2021.11.009

Gregory J. Cannarsa, MD ^a,^⁎ , J. Marc Simard, MD, PhD ^a,^b,^c
^a Department of Neurosurgery, University of Maryland Medical Center, 22 S Greene Street, S12D, Baltimore, MD 21201, USA
^b Department of Pathology, University of Maryland Medical Center, 22 S Greene Street, S12D, Baltimore, MD 21201, USA
^c Department of Physiology, University of Maryland Medical Center, 22 S Greene Street, S12D, Baltimore, MD 21201, USA

^∗Corresponding author.

Résumé

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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Keywords : Decompressive craniectomy, Large hemispheric infarct, Malignant cerebral edema, Ischemic stroke, Glibenclamide

Plan

Key points

Introduction

The nature of the Problem

Evidence Favoring Decompressive Craniectomy for Malignant Cerebral Edema

Age in Decision-Making for Decompressive Craniectomy

The role of the history and physical exam

Timing of intervention

Imaging

Therapeutic options

Decompressive craniectomy: surgical technique

Surgical alternatives to decompressive craniectomy

Complications of decompressive craniectomy

Future directions

Summary

Declaration of interest

Clinics care points

Funding: This article was not funded. JMS is supported by grants from the Department of Veterans Affairs (I01BX002889), the Department of Defense (SCI170199), the National Heart, Lung and Blood Institute (R01HL082517), and the NINDS (R01NS060801; R01NS102589; R01NS105633).^{50Zhao J., Su Y.Y., Zhang Y., et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old Neurocrit Care 2012 ; 17 (2) : 161-171 [inter-ref]

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Vol 40 - N° 2

P. 321-336 - mai 2022 Retour au numéro

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Current State of the Art in Endovascular Stroke Treatment
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Decompressive Craniectomy for Stroke: Who, When, and How - 22/04/22

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