Efficacy of decompressive hemicraniectomy supplemented by infarctectomy and tentoriotomy in surgical treatment of malignant middle cerebral artery infarction: a case series

Objective: The study aimed to assess the efficacy of decompressive hemicraniectomy supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy in the treatment of malignant cerebral infarction (MCI) in the middle cerebral artery (MCA) territory in a series of 7 cases. Methods: We have assessed the results of surgical treatment of 7 patients with MCI in the MCA territory. Mean age of the patients was 57.4 ± 2.8 years (from 47 to 68 years). All patients underwent decompressive hemicraniectomy (DHC), supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy. In order to assess the safety of resection and the absence of a risk of developing additional neurological deficit, a morphological investigation of the resected ischemic brain tissue of the anterior temporal lobe was performed. Results: During the dynamic observation the maximum severity score according to the National Institutes of Health Stroke Scale amounted to 35 points. Among patients, underwent decompressive hemicraniectomy supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy, no cases of death were registered in the postoperative period. Morphological examination of the biopsy material of the resected ischemic anterior temporal lobe confirmed the emergence of irreversible changes in brain tissue. Conclusion: An analysis of the results of 7 investigated cases showed the efficacy of decompressive hemicraniectomy, supplemented by resection of the ischemic anterior part of the temporal lobe and tentoriotomy, in the treatment of MCI in the MCA infarction, and a decrease in the level of postoperative mortality. The approach presented requires further continuation of the study.