Surgery for ischaemic stroke and management of cerebral oedema

Patients with a large cerebral infarction generally have a poor prognosis.

Hemicraniectomy, where a large flap of the skull is removed and the dura membrane is opened to relieve intracranial pressure, should be considered for large life-threatening, space-occupying brain oedema due to ischaemic stroke or middle cerebral artery (MCA) infarcts, also called ‘malignant infarction’ as the condition is associated with 80% mortality due to herniation during the first week.

This is despite maximal conservative treatment in the intensive care unit (ICU), including osmotherapy, barbiturates, and hyperventilation. Conservative management of brain oedema is not supported by clinical trials.

For current research and evidence-based recommendations see our Clinical Guidelines.