Massive cerebral infarction is often accompanied by early death, secondary to brain edema and trans-tentorial herniation. Several reports indicate beneficial effects of decompressive craniectomy in this situation, but the efficacy of this procedure is still a matter of debate.
An experimental study in a period of 3 years was done on 23 patients with brain edema due to massive cerebral infarction; 11 patients were subjects and were operated, and 12 were in the non-operated group who only underwent conservative treatment. All patients in this study had GCS below 8.
The mean age of the operated patients was 54.5 years and for the unoperated patients 64.4 years. Mean GCS in the operated cases was 7.00 and in the unoperated cases was 7.66. In the operated group 4 of 11 patients lived (36.4%) and in the unoperated group 1 of 12 cases lived (8.3%). In the living operated cases, 1 had GOS 4 and 3 cases had GOS 3. In unoperated cases 1 patient lived that had a GOS of 2.
These results show that decompressive craniectomy can be an effective lifesaving procedure for malignant brain edema after cerebral infarction and can also give acceptable functional recovery.
