Decompressive Craniectomy In Acute Ischemic Stroke

Abstract

Acute ischemia in the territory of the middle cerebral artery or internal carotid arterycan lead to massive cerebral edema with raised intracranial pressure and progression to subfalcine or transtentorial herniation and death about 15% of the patients. in stroke patients with massive unilateral hemispheric edema, who detoriate despite maximum medical therapy, decompessive craniectomy may be life saving therapeuticalternative. The clinical data have been published on the usefulness of decompressive craniectomy not only ischemic diseases of large vessells but also posttraumatic and infectious cerebral edema that lead to herniation. However the selection of the patients and timing are stili discussed but it is tought that the stroke patients must be operatedwhen clinical decline occur before the symptoms of herniation appear. The surgical technique consists of large bone flap removal and duraplasty then 6-12 weeks later implantation of an artificial bone flap. İn this review, indications, timing and techniquesof decompressive craniectomy were discussed.