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Hemicraniectomy for malignant middle cerebral artery territory infarction: an updated review.
MedLine Citation:
PMID:  25423133     Owner:  NLM     Status:  Publisher    
BACKGROUND: A decompressive hemicraniectomy is frequently performed for patients with malignant middle cerebral artery territory infarction (MMI) to reduce the intracranial hypertension, which may otherwise result in transtentorial herniation. However, certain clinically significant issues-diagnostic criteria, predictors of the MMI clinical course, benefit of surgery in certain populations, timing of surgery-are unresolved. In this article, we provide an updated review on the diagnosis and management of MMI.
METHODS: An extensive search of the PubMed, EMBASE, and Cochrane was conducted using varying combinations of the search terms, "hemicraniectomy," "decompressive craniectomy," "malignant middle cerebral artery territory infarction," "massive middle cerebral artery territory infarction," "massive ischemic stroke," "decompressive surgery," and "neurosurgery for ischemic stroke."
CONCLUSIONS: Several large, randomized trials within the past decade have firmly established the benefit of decompressive hemicraniectomy (DHC) as a treatment of MMI. Further studies since then have not only better characterized the diagnosis and predictors of MMI, but have also shown that this benefit extends to patients with additional clinical and demographic characteristics. Future randomized studies should continue to evaluate the benefit of a DHC in other subgroups, and assess neurocognitive and psychosocial secondary outcomes.
B Taylor; M LoPresti; G Appelboom; E S Connolly
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-25
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  -     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-25     Completed Date:  -     Revised Date:  2014-11-26    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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