Download PDF
Semin Respir Crit Care Med 2017; 38(06): 737-744
DOI: 10.1055/s-0037-1607992
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Decompressive Craniectomy for Malignant Middle Cerebral Artery Stroke

Mark M. Landreneau
1   Section of Neurocritical Care and Emergency Neurology, Yale University, New Haven, Connecticut
,
Kevin N. Sheth
2   Department of Neurology, Yale University, New Haven, Connecticut
› Author Affiliations
Further Information

Publication History

Publication Date:
20 December 2017 (online)

   Permissions and Reprints

Abstract

Advancements in the treatment of ischemic stroke have led to a recent decline in overall stroke mortality, but patients with hemispheric infarcts remain at high risk for death. Recent advances in the approach to this devastating disease include early identification of patients at high risk for swelling and standardized approaches to medical therapy. However, surgical decompression continues to be the most effective treatment for malignant edema from large hemispheric strokes. Patient selection in the past had been strictly limited to younger ages and the nondominant hemisphere. More recent evidence demonstrates a mortality benefit in older patients with a limited impact on morbidity. Judicious patient selection and shared, informed decision making with families remain the optimal approach for this devastating disease.

Keywords

Decompressive Craniectomy - decompressive hemicraniectomy - malignant - ischemic stroke - middle cerebral artery stroke - hemispheric stroke - malignant edema - surgical decompression - stroke edema
 

  • References

  • 1 Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 1996; 53 (04) 309-315
    CrossrefPubMedGoogle Scholar
  • 2 Alexander P, Heels-Ansdell D, Siemieniuk R. , et al. Hemicraniectomy versus medical treatment with large MCA infarct: a review and meta-analysis. BMJ Open 2016; 6 (11) e014390
    CrossrefPubMedGoogle Scholar
  • 3 Wijdicks EF, Sheth KN, Carter BS. , et al; American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (04) 1222-1238
    CrossrefPubMedGoogle Scholar
  • 4 Torbey MT, Bösel J, Rhoney DH. , et al. Evidence-based guidelines for the management of large hemispheric infarction : a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care 2015; 22 (01) 146-164
    CrossrefPubMedGoogle Scholar
  • 5 Ropper AH. Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med 1986; 314 (15) 953-958
    CrossrefPubMedGoogle Scholar
  • 6 Cucchiara BL, Kasner SE, Wolk DA. , et al; CLASS-I Investigators. Early impairment in consciousness predicts mortality after hemispheric ischemic stroke. Crit Care Med 2004; 32 (01) 241-245
    CrossrefPubMedGoogle Scholar
  • 7 Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke 1999; 30 (02) 287-292
    CrossrefPubMedGoogle Scholar
  • 8 Ng LK, Nimmannitya J. Massive cerebral infarction with severe brain swelling: a clinicopathological study. Stroke 1970; 1 (03) 158-163
    CrossrefPubMedGoogle Scholar
  • 9 Jaramillo A, Góngora-Rivera F, Labreuche J, Hauw JJ, Amarenco P. Predictors for malignant middle cerebral artery infarctions: a postmortem analysis. Neurology 2006; 66 (06) 815-820
    CrossrefPubMedGoogle Scholar
  • 10 Kasner SE, Demchuk AM, Berrouschot J. , et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 2001; 32 (09) 2117-2123
    CrossrefPubMedGoogle Scholar
  • 11 Williams JL, Furlan AJ. Cerebral vascular physiology in hypertensive disease. Neurosurg Clin N Am 1992; 3 (03) 509-520
    CrossrefPubMedGoogle Scholar
  • 12 von Kummer R, Meyding-Lamadé U, Forsting M. , et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol 1994; 15 (01) 9-15 , discussion 16–18
    PubMedGoogle Scholar
  • 13 Park J, Goh DH, Sung JK, Hwang YH, Kang DH, Kim Y. Timely assessment of infarct volume and brain atrophy in acute hemispheric infarction for early surgical decompression: strict cutoff criteria with high specificity. Acta Neurochir (Wien) 2012; 154 (01) 79-85
    CrossrefPubMedGoogle Scholar
  • 14 MacCallum C, Churilov L, Mitchell P, Dowling R, Yan B. Low Alberta Stroke Program Early CT score (ASPECTS) associated with malignant middle cerebral artery infarction. Cerebrovasc Dis 2014; 38 (01) 39-45
    CrossrefPubMedGoogle Scholar
  • 15 Ryoo JW, Na DG, Kim SS. , et al. Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps. J Comput Assist Tomogr 2004; 28 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 16 Kucinski T, Koch C, Grzyska U, Freitag HJ, Krömer H, Zeumer H. The predictive value of early CT and angiography for fatal hemispheric swelling in acute stroke. AJNR Am J Neuroradiol 1998; 19 (05) 839-846
    PubMedGoogle Scholar
  • 17 Kim H, Jin ST, Kim YW, Kim SR, Park IS, Jo KW. Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography. J Clin Neurosci 2015; 22 (03) 554-560
    CrossrefPubMedGoogle Scholar
  • 18 Firlik AD, Yonas H, Kaufmann AM. , et al. Relationship between cerebral blood flow and the development of swelling and life-threatening herniation in acute ischemic stroke. J Neurosurg 1998; 89 (02) 243-249
    CrossrefPubMedGoogle Scholar
  • 19 Oppenheim C, Samson Y, Manaï R. , et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke 2000; 31 (09) 2175-2181
    CrossrefPubMedGoogle Scholar
  • 20 Thomalla G, Hartmann F, Juettler E. , et al; Clinical Trial Net of the German Competence Network Stroke. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. Ann Neurol 2010; 68 (04) 435-445
    CrossrefPubMedGoogle Scholar
  • 21 Beck C, Kruetzelmann A, Forkert ND. , et al. A simple brain atrophy measure improves the prediction of malignant middle cerebral artery infarction by acute DWI lesion volume. J Neurol 2014; 261 (06) 1097-1103
    CrossrefPubMedGoogle Scholar
  • 22 Berrouschot J, Barthel H, von Kummer R, Knapp WH, Hesse S, Schneider D. 99m technetium-ethyl-cysteinate-dimer single-photon emission CT can predict fatal ischemic brain edema. Stroke 1998; 29 (12) 2556-2562
    CrossrefPubMedGoogle Scholar
  • 23 Dohmen C, Bosche B, Graf R. , et al. Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke 2003; 34 (09) 2152-2158
    CrossrefPubMedGoogle Scholar
  • 24 Büttner T, Weyers S, Postert T, Sprengelmeyer R, Kuhn W. S-100 protein: serum marker of focal brain damage after ischemic territorial MCA infarction. Stroke 1997; 28 (10) 1961-1965
    CrossrefPubMedGoogle Scholar
  • 25 Foerch C, Otto B, Singer OC. , et al. Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusion. Stroke 2004; 35 (09) 2160-2164
    CrossrefPubMedGoogle Scholar
  • 26 Serena J, Blanco M, Castellanos M. , et al. The prediction of malignant cerebral infarction by molecular brain barrier disruption markers. Stroke 2005; 36 (09) 1921-1926
    CrossrefPubMedGoogle Scholar
  • 27 Zhao BQ, Tejima E, Lo EH. Neurovascular proteases in brain injury, hemorrhage and remodeling after stroke. Stroke 2007; 38 (2, Suppl): 748-752
    CrossrefPubMedGoogle Scholar
  • 28 Ong CJ, Gluckstein J, Laurido-Soto O, Yan Y, Dhar R, Lee JM. Enhanced detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score: a risk prediction tool. Stroke 2017; 48 (07) 1969-1972
    CrossrefPubMedGoogle Scholar
  • 29 Shimoyama T, Kimura K, Uemura J. , et al. The DASH score: a simple score to assess risk for development of malignant middle cerebral artery infarction. J Neurol Sci 2014; 338 (1-2): 102-106
    CrossrefPubMedGoogle Scholar
  • 30 Jo K, Bajgur SS, Kim H, Choi HA, Huh PW, Lee K. A simple prediction score system for malignant brain edema progression in large hemispheric infarction. PLoS One 2017; 12 (02) e0171425
    CrossrefPubMedGoogle Scholar
  • 31 Bereczki D, Fekete I, Prado GF, Liu M. Mannitol for acute stroke. Cochrane Database Syst Rev 2007; (03) CD001153
    PubMedGoogle Scholar
  • 32 Righetti E, Celani MG, Cantisani T, Sterzi R, Boysen G, Ricci S. Glycerol for acute stroke. Cochrane Database Syst Rev 2004; (02) CD000096
    PubMedGoogle Scholar
  • 33 Hofmeijer J, van der Worp HB, Kappelle LJ. Treatment of space-occupying cerebral infarction. Crit Care Med 2003; 31 (02) 617-625
    CrossrefPubMedGoogle Scholar
  • 34 Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev 2011; (09) CD000064
    PubMedGoogle Scholar
  • 35 Kimberly WT, Battey TW, Pham L. , et al. Glyburide is associated with attenuated vasogenic edema in stroke patients. Neurocrit Care 2014; 20 (02) 193-201
    CrossrefPubMedGoogle Scholar
  • 36 Curry Jr WT, Sethi MK, Ogilvy CS, Carter BS. Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery 2005; 56 (04) 681-692 , discussion 681–692
    CrossrefPubMedGoogle Scholar
  • 37 Scarcella G. Encephalomalacia simulating the clinical and radiological aspects of brain tumor; a report of 6 cases. J Neurosurg 1956; 13 (04) 278-292
    CrossrefPubMedGoogle Scholar
  • 38 Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 2004; 35 (02) 539-543
    CrossrefPubMedGoogle Scholar
  • 39 Honeybul S, Ho KM, Gillett G. Outcome following decompressive hemicraniectomy for malignant cerebral infarction: ethical considerations. Stroke 2015; 46 (09) 2695-2698
    CrossrefPubMedGoogle Scholar
  • 40 Back L, Nagaraja V, Kapur A, Eslick GD. Role of decompressive hemicraniectomy in extensive middle cerebral artery strokes: a meta-analysis of randomised trials. Intern Med J 2015; 45 (07) 711-717
    CrossrefPubMedGoogle Scholar
  • 41 Vahedi K, Vicaut E, Mateo J. , et al; DECIMAL Investigators. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL trial). Stroke 2007; 38 (09) 2506-2517
    CrossrefPubMedGoogle Scholar
  • 42 Jüttler E, Schwab S, Schmiedek P. , et al; DESTINY Study Group. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38 (09) 2518-2525
    CrossrefPubMedGoogle Scholar
  • 43 Geurts M, van der Worp HB, Kappelle LJ, Amelink GJ, Algra A, Hofmeijer J. ; HAMLET Steering Committee. Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial. Stroke 2013; 44 (09) 2506-2508
    CrossrefPubMedGoogle Scholar
  • 44 Jüttler E, Unterberg A, Woitzik J. , et al; DESTINY II Investigators. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med 2014; 370 (12) 1091-1100
    CrossrefPubMedGoogle Scholar
  • 45 Frank JI, Schumm LP, Wroblewski K. , et al; HeADDFIRST Trialists. Hemicraniectomy and durotomy upon deterioration from infarction-related swelling trial: randomized pilot clinical trial. Stroke 2014; 45 (03) 781-787
    CrossrefPubMedGoogle Scholar
  • 46 Zhao J, Su YY, Zhang Y. , et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit Care 2012; 17 (02) 161-171
    CrossrefPubMedGoogle Scholar
  • 47 Vahedi K, Hofmeijer J, Juettler E. , et al; DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6 (03) 215-222
    CrossrefPubMedGoogle Scholar
  • 48 Slezins J, Keris V, Bricis R. , et al. Preliminary results of randomized controlled study on decompressive craniectomy in treatment of malignant middle cerebral artery stroke. Medicina (Kaunas) 2012; 48 (10) 521-524
    PubMedGoogle Scholar
  • 49 Kastrau F, Wolter M, Huber W, Block F. Recovery from aphasia after hemicraniectomy for infarction of the speech-dominant hemisphere. Stroke 2005; 36 (04) 825-829
    CrossrefPubMedGoogle Scholar
  • 50 Solomon NA, Glick HA, Russo CJ, Lee J, Schulman KA. Patient preferences for stroke outcomes. Stroke 1994; 25 (09) 1721-1725
    CrossrefPubMedGoogle Scholar
  • 51 Forsting M, Reith W, Schäbitz WR. , et al. Decompressive craniectomy for cerebral infarction. An experimental study in rats. Stroke 1995; 26 (02) 259-264
    CrossrefPubMedGoogle Scholar
  • 52 Doerfler A, Engelhorn T, Heiland S, Benner T, Forsting M. Perfusion- and diffusion-weighted magnetic resonance imaging for monitoring decompressive craniectomy in animals with experimental hemispheric stroke. J Neurosurg 2002; 96 (05) 933-940
    CrossrefPubMedGoogle Scholar
  • 53 Dasenbrock HH, Robertson FC, Vaitkevicius H. , et al. Timing of decompressive hemicraniectomy for stroke: a nationwide inpatient sample analysis. Stroke 2017; 48 (03) 704-711
    CrossrefPubMedGoogle Scholar
  • 54 Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. ; HAMLET investigators. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009; 8 (04) 326-333
    CrossrefPubMedGoogle Scholar
  • 55 Akins PT, Guppy KH. Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care 2008; 9 (02) 269-276
    CrossrefPubMedGoogle Scholar
  • 56 Sarov M, Guichard JP, Chibarro S. , et al; DECIMAL investigators. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke 2010; 41 (03) 560-562
    CrossrefPubMedGoogle Scholar
  • 57 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30 (06) 473-483
    CrossrefPubMedGoogle Scholar
  • 58 Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Håheim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke 1998; 29 (05) 895-899
    CrossrefPubMedGoogle Scholar
  • 59 Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke 1999; 30 (10) 2131-2140
    CrossrefPubMedGoogle Scholar
  • 60 Rahme R, Zuccarello M, Kleindorfer D, Adeoye OM, Ringer AJ. Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living?. J Neurosurg 2012; 117 (04) 749-754
    CrossrefPubMedGoogle Scholar
  • 61 Hofmeijer J, van der Worp HB, Kappelle LJ, Eshuis S, Algra A, Greving JP. ; HAMLET Steering Committee. Cost-effectiveness of surgical decompression for space-occupying hemispheric infarction. Stroke 2013; 44 (10) 2923-2925
    CrossrefPubMedGoogle Scholar