Decompressive Craniectomy for Large Hemispheric Ischemic Stroke: Surgical Results in Nine Patients

Introduction: Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for post-stroke. A large hemispheric ischemic stroke is a severe form of stroke that may occur in up to 10% of stroke cases. In these cases, decompressive craniectomy (DC) is an effective strategy to reduce early case fatality. In this study, the authors present their experience in the management of large hemispheric stroke in patients who underwent decompressive craniectomy. Patients and Methods: This study is a retrospective analysis of 9 patients who underwent decompressive craniotomy for large hemispheric stroke from February 2021 to January 2024. Demographic, clinical, and radiologic variables were collected from the hospital archives. All patients underwent head CT scan or MRI showing the involvement of the majority or complete middle cerebral artery distribution area. Hemicraniectomy with duraplasty was the main surgical procedure. The mortality and the outcome using Modified Rankin Scale (mRS) were reported. Results: A total of 9 patients with large hemispheric stroke who underwent DC were reviewed retrospectively. The mean age was 53 years with extremes of 39- and 67-year-old. There were 6 males and 3 females. The main risk factors of stroke were hypertension and diabetes in 5 and 3 cases, respectively. The large craniectomy was made and the dura was opened in the stellate fashion. Duraplasty was performed using epicrane in 7 patients and fascia lata aponeurosis in 2 patients. In the postoperative course, 4 (44%) patients died in 1 month and the mortality rate was 66.6% in 6 months. Conclusion: Decompressive craniectomy is a life-saving procedure used to manage cerebral edema after stroke onset. In our study, the high mortality rate could be explained by many factors, such as patient selection criteria and timing of surgery. Early surgery within the first 48 hours in patients less than 60 years old with large hemispheric stroke is recommended.