Review
Hemicraniectomy for malignant middle cerebral artery infarction: Current status and future directions
Hermann Neugebauer,
Eric Jüttler,
Corresponding Author
Hermann Neugebauer
Department of Neurology, RKU – University and Rehabilitation Hospitals, Ulm, Germany
Correspondence: Hermann Neugebauer, Department of Neurology, RKU – University and Rehabilitation Hospitals Ulm, Oberer Eselsberg 45, Ulm 89081, Germany.
E-mail: [email protected]
Search for more papers by this authorEric Jüttler
Department of Neurology, RKU – University and Rehabilitation Hospitals, Ulm, Germany
Search for more papers by this authorHermann Neugebauer,
Eric Jüttler,
Corresponding Author
Hermann Neugebauer
Department of Neurology, RKU – University and Rehabilitation Hospitals, Ulm, Germany
Correspondence: Hermann Neugebauer, Department of Neurology, RKU – University and Rehabilitation Hospitals Ulm, Oberer Eselsberg 45, Ulm 89081, Germany.
E-mail: [email protected]
Search for more papers by this authorEric Jüttler
Department of Neurology, RKU – University and Rehabilitation Hospitals, Ulm, Germany
Search for more papers by this authorFirst published: 11 April 2014
*HeADDFIRST was finally published in the March 2014 issue of Stroke (Frank JI1, Schumm LP, Wroblewski K, et al. Hemicraniectomy and durotomy upon deterioration from infarction-related swelling trial: randomized pilot clinical trial. Stroke 2014;45:781–7).
Conflict of interest: None declared.
Abstract
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.
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