Craniectomy for middle cerebral artery infarction

Abstract

Acute occlusion of the major intracerebral arteries produces brain ischaemia and cerebral oedema with an attendant rise in intracranial pressure producing an intracranial compartment syndrome (‘malignant’ stroke). Over the course of 2003, three patients referred to the authors' unit underwent craniectomy for space-occupying malignant cerebral oedema following acute middle cerebral artery infarction. Each case deteriorated acutely following the initial event. Details regarding each patient’s initial clinical state, mode of deterioration and clinical outcomes are briefly described. On each occasion the preoperative computed tomography (CT) scan showed signs of a large middle cerebral artery territory infarction and was consistent with space occupation and mass effect. The postoperative CT scans demonstrated evidence of expansion of the oedematous brain tissue, most pronounced in case 2. These findings are illustrated in Figures 1a and b.