Hemicraniectomy in Older Stroke Patients

Middle cerebral artery (MCA) territory infarcts with life-threatening edema — previously termed “malignant” MCA infarcts — carry a mortality rate as high as 80%. Hemicraniectomy (HC) is a surgical treatment option that allows pressure gradients to be directed outward instead of toward the brainstem, thereby potentially preventing brain herniation. In patients younger than 60, HC substantially reduces mortality without increasing the rate of severe disability. To evaluate whether older patients would also benefit from HC, investigators randomized 112 patients (median age, 70; range, 61–82) to receive either standard intensive care unit (ICU) treatment alone or ICU treatment plus HC. The primary endpoint was a score of 0 to 4 (survival withou…