OBJECTIVE Malignant middle cerebral artery (MCA) infarction occurs in 10% of all ischemic strokes and these severe strokes are associated with high mortality rates. Recent clinical trials demonstrated that early decompressive craniectomy reduce mortality rates and improves functional outcomes in healthy young patients (less than 61 years of age) with a malignant infarction. The purpose of this ...

BACKGROUND Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functi...

Spinal cord Sarcoidosis was first described by Longcope in 1941 (Longcope, 1941), and since then, spinal cord involvement has been reported in less than 10% of patients with neurosarcoidosis (Bogousslavsky et al., 1982, Fried et al., 1993) Spinal cord sarcoidosis is a chronic, granulomatous, systemic inflammatory disease, although precise understanding of the pathogenesis remains unclear, and m...

BACKGROUND Malignant infarction of the middle cerebral artery (MCA) is associated with an 80% mortality rate. Non-randomised studies have suggested that decompressive surgery reduces this mortality without increasing the number of severely disabled survivors. To obtain sufficient data as soon as possible to reliably estimate the effects of decompressive surgery, results from three European rand...

OBJECTIVE Decompressive surgery is one of the available options in dealing with traumatic brain injury (TBI) when clinical and radiological evidence confirm that medical treatment may be insufficient. This can be achieved either by complete removal of the bone or by allowing it to float, but the indications and utility of these are yet to be resolved. This study examines the indications and out...

OBJECT Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. Recent studies have supported decompressive surgery over radiation therapy for patients who present with MESCC. These studies, however, have grouped all patients with different histological types of metastatic disease ...

BACKGROUND AND PURPOSE Malignant, space-occupying supratentorial ischemic stroke is characterized by a mortality rate of up to 80%. Several reports indicate a beneficial effect of hemicraniectomy in this situation. However, whether and when decompressive surgery is indicated in these patients is still a matter of debate. METHODS In an open, prospective trial we performed hemicraniectomy in 63...

To the Editor: We read with great interest the article by Livesay et al entitled “Evidence-Based Nursing Review of Craniectomy Care.” First, we applaud the authors for this excellent summary of nursing care and for the table of nursing monitoring and discussion of other concerns regarding patients with decompressive craniectomy. The summary they provide is useful, and we hope to educate our nur...

The original randomized, controlled clinical trials that established the efficacy of decompressive hemicraniectomy after space-occupying, malignant cerebral artery infarction were neither designed nor powered to evaluate the optimal timing of intervention. Because of the time frame used as enrollment criteria in these clinical trials, the initial pooled analysis was restricted to patients treat...