Acute Supratentorial Ischemic Stroke: When Surgery Is Mandatory

Abstract

Acute occlusion of middle cerebral artery (MCA) leads to severe brain swelling and to a malignant, often fatal syndrome. The authors summarize the current knowledge about such a condition and review the main surgical issues involved. Decompressive hemicraniectomy keeps being a valid option in accurately selected patients.

Decompressive Craniotomy in the Treatment of Malignant Ischemic Stroke of Cerebral Hemispheres (Review)

“…All that contributes to the infarction zone growth and progressive pathological process on a vicious circle principle [5,26,38]. Other satellite reactions are the following: impaired microvascular tone, edema of endothelial cells, activation of platelets, leukocytes and blood coagulation system [18]. Transtentorial herniation is the major reason for lethality in MIS.…”

“…Infarction area volume is related to S100B level. The blood serum protein 24 h after the onset of the disease is 1.03 µg/L, and coupled with sensitivity (94%) and specificity (84%) can be a sign of massive cerebral edema [18]. Unfortunately, currently, the diagnostic technique is not available in any hospital, and its reliability in prognosis should be proved by larger studies.…”

“…Operative therapy should be preventive and ahead of the dislocation syndrome [18,29]. A surgery cannot resuscitate "dead" neurons.…”

“…There is a special category of ACVD patients with the so called malignant ischemic stroke (MIS), which occurs in 10-15% cases [17][18][19][20][21][22][23][24][25]. MIS is understood as stroke with an extensive cerebral ischemic area with post-ischemic edema and lateral and/or axial brain dislocation [22,25,26].…”

“…More frequently, MIS develops in young patients due to the absence of atrophy and lower brain tolerance. Patients with malignant course of the disease were found to be 10 years younger on the average than those with an ordinary IS course [18]. The mortality rate in MIS patients is 70-80%, and disability among survived patients is 80% [17-21, 23, 24, 26, 28-34].…”