Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

The concept of decompressive surgery for treatment ofelevated intracranial pressure has been developed al-ready in the beginning of the 20th century.1 The rationale of this treatment modality consists of opening of the skull and removal of a bone flap to allow the edematous brain to swell outward, thereby preventing intracranial tissue shifts and life-threatening downward herniation. The use of decompres-sive hemicraniectomy (DHC) in the context of ischemic brain edema had been reported already in 1956.2 Since that time, DHC has been increasingly studied in the setting of different conditions, including traumatic brain injury, subarachnoid hemorrhage, and malignant middle cerebral artery (MCA) infarction. Depending on the location of the affected area, different surgical decompression techniques have been developed. In the presence of diffuse brain edema without a midline shift, as