Decompressive craniectomy in ischemic stroke

Matthew Jaffa, Carolyn A. Cronin, Barney J. Stern

Research output: Chapter in Book/Report/Conference proceedingChapter


Few stroke syndromes have as high a risk of mortality or severe disability as does the "malignant" middle cerebral artery infarction seen in the setting of large artery occlusions. Malignant stroke syndromes are relatively rare; however, when present they are associated with a close to 80% mortality rate. The management of these patients is controversial and presents a major challenge for the neurologists, neurosurgeons, and neurointensivists caring for them. Many studies have assessed the benefits and risks of decompressive craniotomy versus optimal medical management, with the goal of improving not only survival but also survival with good functional outcomes. The conclusions of these studies remain mixed, and practice patterns vary widely. We review the landmark trials of decompressive surgery in ischemic stroke as well as the pooled analyses and those addressing quality of life to improve our understanding of this complicated syndrome in which the optimal management strategy may vary depending on a patient's values and preferences.

Original languageEnglish (US)
Title of host publicationDecompressive Craniectomy
PublisherNova Science Publishers, Inc.
Number of pages20
ISBN (Electronic)9781536131819
ISBN (Print)9781536131802
StatePublished - Jan 1 2018


  • Decompressive craniotomy
  • Functional outcomes
  • Large artery occlusion
  • Malignant stroke
  • Quality of life

ASJC Scopus subject areas

  • Medicine(all)
  • Neuroscience(all)


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