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Decompressive Hemicraniectomy for Middle Cerebral Artery Stroke: Indications and Perioperative Care
Author(s) -
Karasin Beth,
Grzelak Monica,
Rizzo Gina,
Hardinge Tara,
Eskuchen Lauren,
Boyce Marissa,
Watkinson Johanna
Publication year - 2021
Publication title -
aorn journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 43
eISSN - 1878-0369
pISSN - 0001-2092
DOI - 10.1002/aorn.13430
Subject(s) - medicine , stroke (engine) , perioperative , middle cerebral artery , cerebral edema , presentation (obstetrics) , decompression , brain edema , intensive care medicine , surgery , anesthesia , cardiology , ischemia , mechanical engineering , engineering
Decompressive hemicraniectomy (DHC) is a procedure performed in the setting of malignant cerebral edema after a large middle cerebral artery stroke. The decision to proceed with surgical decompression is one that must be made judiciously and rapidly. Although this can be a life‐saving surgery, it does not necessarily improve the patient’s quality of life. The neurosurgical team must thoroughly discuss the patient’s comorbidities, age, dominant versus nondominant hemispheric injury, and neurological expectations, and the procedure itself (ie, risks, benefits, expected postoperative course, goals of care) with the patient and his or her family before DHC. This article briefly reviews the anatomy of the brain and stroke presentation and provides an overview of DHC and the perioperative course. The article concludes with a case study of a patient with a medical history of hypertension and prediabetes who presents to the emergency department after a fall and undergoes an emergent DHC.