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Bendok, Bernard R. et al.: 2025 Hemorrhagic and Ischemic Stroke DOI: 10.1055/b-0044-205929
Section III Open Surgical, Minimally Invasive and Microsurgical Approaches

28 Open Surgery and Craniectomy for Malignant Stroke and ICH

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Editors: Bendok, Bernard R.; Batjer, H. Hunt

Authors: Abi-Aad, Karl; Abuelem, Tarek; Açiş, Onur; Agnoletto, Guilherme J.; El Ahmadieh, Tarek; Albuquerque, Felipe C.; Amenta, Peter S.; Amoss, James; Aoun, Salah G.; Arthur, Adam S.; Awad, Issam A.; Ban, Vin Shen; Barrow, Daniel L.; Bebawy, John F.; Biller, José; Binning, Mandy J.; Blech, Benzion; Bonney, Phillip A.; Brasiliense, Leonardo B.C.; Carlin, Rachel E.; Carrión-Penagos, Julián; Chong, Brian W.; Christel, Lynda M.; Church, Ephraim W.; Connolly, E. Sander; Connor, Michelle; Dalfino, John C.; Demaerschalk, Bart M.; Dumitrascu, Oana M.; Entezami, Pouya; Felbaum, Daniel; Freeman, W. David; Garcia, Jose Omar; Goyal, Nitin; Granja, Manuel F.; Hanel, Ricardo A.; Heiferman, Daniel M.; Hemphill, J. Claude; Hess, Ryan; Howard, Brian M.; Hudson, Miles; Ingall, Timothy J.; Inoa, Violiza; Jabbour, Pascal M.; Jacob, Sneha; Johnson, Mark D.; Kalen, Brian; Kicielinski, Kimberly P.; Koester, Stefan W.; Koht, Antoun; Kondziolka, Douglas; Krishna, Chandan; Kronenburg, Annick; Kumar, Gyanendra; Langer, David; Levy, Elad I.; Mack, William J.; Merrill, Sarah; Meyer, Fredric B.; Monteiro, André; Montaño, Arturo; El Naamani, Kareem; Nossek, Erez; O’Carroll, Cumara B.; Ogilvy, Christopher S.; Ogunsola, Oludotun; Ottenhoff, Lauren; Oushy, Soliman; Patel, Bhavesh; Patra, Devi P.; Peacock, Sarah; Pena, Austin; Pines, Andrew; Polster, Sean P.; Rahme, Rudy J.; Rebeiz, Tania; Riina, Howard; Rinaldo, Lorenzo; Sattur, Mithun G.; Sen, Ayan; Siegel, Jason; Sim, Justin L.; Simon, Scott D.; Solomon, Robert A.; Spetzler, Robert; Sweid, Ahmad; Syal, Arjun; Tomlinson, Amanda; Turcotte, Evelyn L.; Turkmani, Ali H.; Vakharia, Kunal; Vanderhye, Vanesa K.; Veznedaroglu, Erol; Walia, Parampreet Singh; Waqas, Muhammad; Welch, Babu G.; Welz, Matthew E.; White, Jonathan A.; Winter, JoDee; Zaatar, Muriel T.; Zeeni, Carine

Title: Hemorrhagic and Ischemic Stroke

Subtitle: Medical, Imaging, Surgical, and Interventional Approaches

Print ISBN: 9781684200436; Online ISBN: 9781684203819; Book DOI: 10.1055/b000000291

2. Edition © 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc., New York

Subjects: Neurosurgery

Thieme Clinical Collections (English Language)



 
Kimberly P. Kicielinski and Christopher S. Ogilvy

Abstract

Malignant stroke is defined as a large middle cerebral artery infarct, with or without anterior and posterior territory involvement, associated with significant acute cerebral edema and high intracranial pressure. Even with best medical practice, it is associated with high mortality rates. Decompressive hemicraniectomy is a life-saving surgical intervention. The indications and timing of this procedure, while clear in some cases, can be controversial. In this chapter, we review the existing literature and evidence for surgical management of both acute ischemic stroke complicated by malignant edema and supratentorial intraparenchymal hemorrhage. Treatment of intraparenchymal hemorrhage by both direct evacuation and craniectomy alone is explored. Evidence on complications and timing of cranioplasty are also discussed. Current guidelines and recommendations for care are included.

Key words

intracranial hemorrhage - malignant stroke - craniotomy - decompressive craniectomy - cerebral edema - cranioplasty
 
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