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Role of Decompressive Hemicraniectomy for Intracranial Hypertension Following Stroke

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Management of Cerebrovascular Disorders

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Abstract

Over the last two decades, there has been resurgence in the use of DCH for a number of neurological emergencies. This includes large-territory ischemic strokes with an increased risk of swelling, herniation, and death. A number of prospective randomized controlled trials, pooled analysis, and meta-analysis have shown strong evidence that the use of DCH reduces mortality in patients who develop MMI. This result is seen irrespective of age, and DCH improves mortality even in patients >60 years of age. However, long-term outcomes, patient selection, and ethical issues still require consideration. Perhaps the most important and yet controversial question that arises when considering DCH for MMI is what constitutes a favorable outcome for the patient. As such, although we can now recommend DCH as a potential therapy for patients with MMI to improve survival, the values and preferences of patients and family must be carefully weighed while arriving at a decision. This is especially pertinent in patients older than 60 years of age, in whom there is a higher likelihood of survival with severe disability. Addressing the issue of “favorable long-term outcome” involving patients and family members should always be a goal of care and should be a goal of future studies. In cases where DCH is considered, early surgery (within 24–48 h of symptom onset) is recommended, prior to onset of any herniation syndrome in order to achieve the best neurological outcome.

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Author information

Authors and Affiliations

  1. Neurology and Neurointerventional Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Seby John

  2. Department of Adult Critical Care Medicine, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada

    James Scozzafava

  3. Division of Stroke Neurology, Neurosciences Program, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    James Scozzafava

  4. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Muhammad Shazam Hussain

Authors
  1. Seby John
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  2. James Scozzafava
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  3. Muhammad Shazam Hussain
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Corresponding author

Correspondence to Muhammad Shazam Hussain .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

    Alejandro M. Spiotta

  2. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

    Raymond D. Turner

  3. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

    M. Imran Chaudry

  4. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

    Aquilla S. Turk

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John, S., Scozzafava, J., Hussain, M.S. (2019). Role of Decompressive Hemicraniectomy for Intracranial Hypertension Following Stroke. In: Spiotta, A., Turner, R., Chaudry, M., Turk, A. (eds) Management of Cerebrovascular Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-99016-3_36

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  • DOI: https://doi.org/10.1007/978-3-319-99016-3_36

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99015-6

  • Online ISBN: 978-3-319-99016-3

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