Decompressive Surgery in Acute Ischemic Stroke

Abstract

Objective: Deterioration of neurologic status during acute stroke may occur secondary to cerebral edema. Acute middle cerebral artery (MCA) infarction may cause uncal herniation, whereas large superior cerebellar artery (SCA) infarction may lead to hydrocephalus, brainstem compression, and transforaminal tonsillar herniation causing thus an increase in mortality and morbidity. Decompression may be life saving in cases of malignant edema secondary to acute ischemia. The aim of this study is to investigate the effect of decompression on mortality and functional outcome in acute ischemic stroke.

Methods: Four patients admitted with acute stroke between January 2001 and January 2002 to the Marmara University Hospital and with rapidly deteriorating Glascow Coma Scale despite medical therapy were included in this study. There were 3 women and one man, aged 46 to 73. Two patients had MCA lesions, one had SCA lesion, and one had bilateral SCA and posterior cerebral artery lesions. The patients who had MCA infarction with rapidly detoriating Glasgow Coma Scale in first 24 hours underwent large hemicraniectomy and duraplasty. Decompressive suboccipital craniectomy was performed in the patients with SCA lesions on the fourth day. Early postoperative NIH Scores of the patients with MCA infarction were 22 versus 24 preoperatively and Rankin Scores were 4 in the third month. In the patients who underwent brainstem decompression Rankin score was one and 2 at the 3rd and 2nd months, respectively.

Conclusion: Decompressive surgery improves survival rates in acute ischemic stroke. Patients with brainstem stroke seem to have a better functional outcome.