Decompressive Hemicraniectomy After Anterior Circulation Ischemic Stroke: A Potentially Life-Saving Procedure That Increases the Chances of a Better Outcome in Stroke Patients with Malignant Brain Infarct with Massive Edema

Malignant cerebral edema, defined as space-occupying swelling with secondary parenchymal damage or even herniation, is a common complication of ischemic stroke and is feared because of its poor prognosis. The occurrence of malignant cerebral edema is observed in the first days after the insult. Endovascular recanalization of the underlying vascular occlusion may reduce the risk of malignant cerebral edema but does not exclude its development. If left untreated, malignant cerebral edema is often fatal or results in a poor outcome, but decompressive hemicraniectomy (DH) can reduce the risk of both. In this chapter, we describe postinterventional critical care management based on the case of a middle-aged woman who developed infarction and malignant cerebral edema despite prompt endovascular recanalization of an occlusion of the internal carotid artery and ipsilateral middle cerebral artery. The neurosurgical management of the patient, essentially by DH, prevented not only the fatal outcome but also major secondary damage from the cerebral edema. In addition, although the patient suffered a severe stroke, she was able to achieve a favorable outcome thanks to intensive neurological rehabilitation.