Treatment of malignant mca infarction

Abstract

Space-occupying malignant middle cerebral artery infarction is one of the most devastating forms of ischemic stroke. Several case series suggested decompressive hemicraniectomy as a life saving therapy, but until recently there has been no proof for this procedure from randomized controlled trials. Recent findings from 2007, and results from pooled analyses of three European trials in 2009 revealed evidence for the benefit of hemicraniectomy. This review focuses on the clinical syndrome, provides information on pathophysiology and imaging modalities, and describes therapeutic options with special regard to decompressive surgery.