Early Decompressive Hemicraniectomy in Older Patients With Nondominant Hemispheric Infarction Does Not Improve Outcome

Space-occupying edema formation is an important cause of death in young patients with large hemispheric infarcts. This complication appears to occur less frequently in elderly patients with similar-sized infarcts, in part because edema may be compensated for by brain atrophy.1 Because the risk of stroke increases almost exponentially with age, space-occupying hemispheric infarcts are still frequently observed in patients older than age 60 years.In a meta-analysis of 3 small randomized trials that compared surgical decompression with conservative treatment in patients with space-occupying infarction, surgery within the first 48 hours of symptom onset increased the chance of a favorable functional outcome at 12 months, defined as a score on the modified Rankin scale ≤3, from 24% to 40%.2 However, each of these trials used an upper age limit of 55 or 60 years. Similar trials have not been performed in older patients.The upper age limit of 60 years in the trials was not without a reason: observational studies have strongly suggested that age is …