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Clinical course and surgical management of massive cerebral infarction.

Publication ,  Journal Article
Robertson, SC; Lennarson, P; Hasan, DM; Traynelis, VC
Published in: Neurosurgery
July 2004

OBJECTIVE: Acute occlusion of the proximal middle cerebral artery (MCA) can lead to rapid development of fatal brain swelling and ischemic strokes. Decompressive surgery, if performed early in this subpopulation of patients, can reduce mortality and result in a favorable outcome. In this article, we describe our surgical approach for treating malignant MCA syndrome and compare it with other management strategies. METHODS: This is a retrospective review of patients who developed acute occlusion of the proximal MCA and underwent aggressive surgical decompression (large craniectomy, anterior temporal lobectomy, resection of infarcted tissue, and duraplasty). The outcome of this management strategy is compared with the previously published outcomes of hemicraniectomy and dural augmentation. RESULTS: Twelve patients were included in the study. The group consisted of six men and six women (mean age, 46.8 yr). Nine patients had right MCA stroke, and three had left MCA infarction. The causes of the strokes were cardioembolic, iatrogenic, small-vessel occlusive disease, and others. The interval between infarction and clinical evidence of herniation varied from 24 hours to 10 days. Two patients died, five were independent or had moderate disabilities, and five had severe disability. CONCLUSION: Surgical decompression consisting of a large craniectomy, anterior temporal lobectomy, resection of infarcted tissue, and duraplasty is beneficial to a significant number of patients with massive MCA stroke and clinical signs of herniation.

Duke Scholars

Published In

Neurosurgery

DOI

ISSN

0148-396X

Publication Date

July 2004

Volume

55

Issue

1

Start / End Page

55 / 61

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Dura Mater
  • Decompression, Surgical
  • Craniotomy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Robertson, S. C., Lennarson, P., Hasan, D. M., & Traynelis, V. C. (2004). Clinical course and surgical management of massive cerebral infarction. Neurosurgery, 55(1), 55–61. https://doi.org/10.1227/01.neu.0000126875.02630.36
Robertson, Scott C., Peter Lennarson, David M. Hasan, and Vincent C. Traynelis. “Clinical course and surgical management of massive cerebral infarction.Neurosurgery 55, no. 1 (July 2004): 55–61. https://doi.org/10.1227/01.neu.0000126875.02630.36.
Robertson SC, Lennarson P, Hasan DM, Traynelis VC. Clinical course and surgical management of massive cerebral infarction. Neurosurgery. 2004 Jul;55(1):55–61.
Robertson, Scott C., et al. “Clinical course and surgical management of massive cerebral infarction.Neurosurgery, vol. 55, no. 1, July 2004, pp. 55–61. Pubmed, doi:10.1227/01.neu.0000126875.02630.36.
Robertson SC, Lennarson P, Hasan DM, Traynelis VC. Clinical course and surgical management of massive cerebral infarction. Neurosurgery. 2004 Jul;55(1):55–61.
Journal cover image

Published In

Neurosurgery

DOI

ISSN

0148-396X

Publication Date

July 2004

Volume

55

Issue

1

Start / End Page

55 / 61

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Dura Mater
  • Decompression, Surgical
  • Craniotomy