Decompressive hemicraniectomy after malignant middle cerebral artery infarction: Rationale and controversies

Omar M. Arnaout, Salah G. Aoun, H. Hunt Batjer, Bernard R. Bendok

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Malignant middle cerebral artery stroke carries a very poor prognosis. Significant retrospective data support the hypothesis that decompressive hemicraniectomy decreases mortality rates due to this disease entity. Recently, 3 randomized controlled studies have been published and shed light on these issues and enhance the quality of evidence revolving around this procedure. In this review, the rationale, risks, benefits, and unanswered questions related to hemicraniectomy for acute ischemic stroke are reviewed with an emphasis on how 3 randomized trials have influenced knowledge on this life-saving yet controversial procedure. Further randomized studies are needed to clarify lingering questions regarding age indications and impact on quality of life.

Original languageEnglish (US)
Article numberE18
JournalNeurosurgical focus
Issue number6
StatePublished - Jun 2011


  • Craniectomy
  • Hemicraniectomy
  • Malignant stroke
  • Patient outcome
  • Quality of life
  • Randomized controlled trial

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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