UNASSIGNED: Background: Space-occupying @entity2500 (MCA) is associated with a high mortality rate of up to 80% under conservative treatment. Although there is convincing evidence that decompression craniectomy can significantly reduce mortality rate and improve neurological outcome in young @entity1 (<60 years), many surgeons are still hesitant to recommend hemicraniectomy for @entity64 @entity1 . Summary: This review addresses some major issues that appear to be an obstacle to decompression craniectomy, in particular, indicating surgery for @entity1 >60 years or with @entity1188 of the dominant hemisphere. Furthermore, it emphasizes technical issues such as timing and size of the craniectomy, additional temporal lobectomy, and resection of the temporal muscle, as well as duraplasty and cranioplasty. According to the current literature, decompression craniectomy in older @entity1 can increase survival without most severe disabilities, although, most survivors need assistance in most bodily needs. Involvement of the dominant hemisphere results in @entity2026 that might partly recover in younger @entity1 , although, considering the @entity51 caused by @entity1188 of the nondominant hemisphere, involvement of the dominant hemisphere does not pose as a contraindication for decompression craniectomy. Furthermore, there is convincing evidence that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum. An additional lobectomy or the resection of the temporal muscle, however, can only be part of individual treatment options. Conceding the weak evidence, it is recommended to close the dura by some form of a duraplasty avoiding cerebrospinal fluid leakages or scarring between the cortex and the scalp leading to injuries during reimplantation of the bone-flap. Complications associated with decompression surgery ( @entity548 , @entity281 , 'sinking @entity272 ', cerebrospinal fluid leakages, @entity1276 , @entity410 ), with the @entity1188 itself, or with those that occur during the ICU course ( @entity299 ) appear acceptable and are mostly treatable, especially considering the fatal course of conservative treatment. Key Message: This review summarizes the current state of the literature about decompression craniectomy of @entity1 with @entity64 addressing, in particular, critical surgical issues, and thus, help surgeons to make decisions confidently for/or against performing surgery.    2014 S. Karger AG, Basel.

Surgical Aspects of Decompression Craniectomy in Malignant XXXX : Review.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity410 :: ('MESH:D012640', 'Disease') :: ['seizures'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke', 'malignant stroke'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhages'] @entity1276 :: ('MESH:D006849', 'Disease') :: ['hydrocephalus'] @entity2500 :: ('MESH:D020244', 'Disease') :: ['malignant stroke of the middle cerebral artery'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac and pulmonary complications'] @entity51 :: ('MESH:D009461', 'Disease') :: ['neuropsychological deficits'] @entity2026 :: ('MESH:D001037', 'Disease') :: ['aphasia'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarctions', 'infarcts', 'infarction'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infections'] @entity272 :: ('MESH:D012871', 'Disease') :: ['skin-flap syndrome']
@entity64 :: (MESH:D020521,Disease) :: ['Stroke']
