Decompressive craniectomy for acute ischemic stroke

Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique aiming to open the...

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Bibliographic Details
Published in:Critical care (London, England) England), 2019-06, Vol.23 (1), p.209-209, Article 209
Main Authors: Beez, Thomas, Munoz-Bendix, Christopher, Steiger, Hans-Jakob, Beseoglu, Kerim
Format: Article
Language:English
Subjects:
Adult
Aged
Brain damage
Care and treatment
Clinical trials
Cranioplasty
Craniotomy - legislation & jurisprudence
Craniotomy - standards
Critical care
Decision making
Decompression (Physiology)
Decompression - methods
Decompression - standards
Decompressive craniectomy
Edema
Female
Hemicraniectomy
Humans
Hypertension
Intracranial hypertension
Intracranial pressure
Ischemia
Male
Malignant ischemic infarction
Medical care quality
Middle Aged
Neurosurgery
Patient outcomes
Pediatric stroke
Pediatrics
Physicians
Precision medicine
Preschool children
Quality of Life
Review
Stroke
Stroke - surgery
Stroke patients
Suboccipital craniectomy
Surgery
Systematic review
Traumatic brain injury
Treatment Outcome
Veins & arteries
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Summary:Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique aiming to open the "closed box" represented by the non-expandable skull in cases of refractory intracranial hypertension. It is a valuable modality in the armamentarium to treat patients with malignant stroke: the life-saving effect has been proven for both supratentorial and infratentorial DC in virtually all age groups. This leaves physicians with the difficult task to decide who will require early or preemptive surgery and who might benefit from postponing surgery until clear evidence of deterioration evolves. Together with the patient's relatives, physicians also have to ascertain whether the patient will have acceptable disability and quality of life in his or her presumed perception, based on preoperative predictions. This complex decision-making process can only be managed with interdisciplinary efforts and should be supported by continued research in the age of personalized medicine.
ISSN:1364-8535
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-019-2490-x