Decompressive Hemicraniectomy in the Age of Personalized Medicine

Excerpt

Ever since the pooled analysis of three randomized controlled trials of early decompressive surgery in malignant infarction of the middle cerebral artery was published in 2007 [1], the consideration of decompressive hemicraniectomy for large hemispheric stroke patients has become widespread. That paper reported on the pooled results of three small randomized trials: DECIMAL [2], DESTINY [3], and HAMLET [4]. While the analysis indicated that the procedure clearly can reduce mortality, considerable controversy persists over whether it improves functional outcome. The essence of the dispute is philosophical and essentially can be distilled down to whether one considers a modified Rankin score of four as a good or a bad outcome. …