Abstract
Acute arterial occlusion, particularly of the internal carotid and middle cerebral arteries, may on occasion produce an acute brain swelling and cause death within a few days especially in younger patients (younger than 65 years). The brain swelling is so rapid that the patients complain headache, nausea, and vomiting with deterioration of consciousness. In older patients however, the brain is more atrophic and contains dilated ventricles that might accomodate localized edema and decrease the degree of midline shift.
Conventional treatments to prevent brain edema consist of the administration of adrenocorticosteroids and hyperosmolar solutions but they may be ineffective in some cases. Some neurosurgeons have treated intracranial vascular obstructions using EC/IC bypass operation, but this must be done within 12 hours after the onset of the disease.
For these reasons, decompressive craniectomy seems to be effective and lifesaving against brain edema in patients with impending tentorial herniation.
The following factors should be taken into consideration in deciding the operation:
1) the age of patient-younger than 65 years; 2) dominance of hemisphere-nondominant hemisphere; 3) associated diseases such as severe heart or lung disease, uncontrolled diabetes mellitus, dementia might adversely influence prognosis ; and 4) the attitude of the family towards preservation of the patient's life.
