Decompressive craniectomy in malignant middle cerebral artery infarction: clinical evidence

Abstract

Malignant middle cerebral artery infarction represents a 5 to 10% of patients withischemic stroke, leading to high mortality and disability. For its treatment, decompressivecraniectomy has been utilized in a selected group of patients.Decompressive craniectomy is a neurosurgical procedure that has been used in thetreatment of a select group of patients. In this paper we review the literature on theeffectiveness of this procedure. Additionally, evidence-based recommendations for thecareful and rational selection of potential candidates for this surgery are also exposed.RESUMEN:El infarto maligno de la arteria cerebral media representa entre 5 a 10% de lospacientes con enfermedad vascular cerebral isquémica, conllevando una alta mortalidady discapacidad funcional. Para su tratamiento ha sido utilizada la craniectomíadescompresiva en un grupo selecto de pacientes. En este escrito es revisada la literaturareferente a la efectividad de este procedimiento. Adicionalmente, son recopiladas lasrecomendaciones basadas en la evidencia para la elección meticulosa y racional delos potenciales candidatos a esta cirugía.

Keywords

• Descompressive craniectomy
• Surgery. Intracranial hypertension
• Herniation
• Cerebral edema
• Midline shift.