Abstract
Background. Roughly 10‒15 percent of ischemic strokes in the area of the middle cerebral artery (MCA) are classified as malignant due to the development of malignant cerebral oedema. In patients with this syndrome receiving only pharmacological treatment the death rate amounts to 80%. The results of randomized controlled trials show clear benefits from decompressive hemicraniectomy, i.e. improved survival rates and better functional outcomes as compared to these attained in conservative medical treatment.
Case reports. The authors present two male patients aged 46 and 53, with malignant MCA infarct managed with rt-PA. Decompressive hemicraniectomy was performed with a favourable early 30-day outcome in both patients. The beneficial outcome of hemicraniectomy was observed at a 3-month follow-up in one patient (his health status was satisfactory, score 3 on the mRs scale). The other patient died suddenly 40 days from stroke, for reasons unrelated to hemicraniectomy.
Commentary. The paper presents a review of the research literature on usefulness of hemicraniectomy in the treatment of malignant cerebral edema in the course of MCA infarction. The authors wanted to share their modest experience, suggesting that hemicraniectomy can be performed in a non-academic center as well, provided that good cooperation with a neurosurgeon is established.