Surgical Management of Acute Stroke

ABSTRACT

Stroke is a most common neurological disease leading to mortality and morbidity. Many clinical evidences confirm that medical treatment including thrombolytic and antithrombotic therapy may improve the clinical outcome in patients with acute ischemic stroke. However, little information exists about effectiveness and safety of reperfusion surgery such as emergency carotid endarterectomy and extracranial-intracranial bypass surgery in patients with acute ischemic stroke and limits its wide application. Recent pooled analysis of three randomized controlled clinical trials-DECIMAL (decompressive craniectomy in malignant middle cerebral artery infarcts) trial; DESTINY (decompressive surgery for the treatment of malignant infarction of the middle cerebral artery) trial; and HAMLET (hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial) reported decompressive surgery undertaken within 48 hours of stroke onset in patients with malignant middle cerebral artery infarction reduced mortality and morbidity. However, decompressive surgery in patients with malignant middle cerebral artery infarction should be done according to the clinical conditions of individual patients. No clear evidences are present on that craniotomy, minimally invasive surgery, and early clot evacuation are effective on functional outcome of patients with spontaneous intracerebral hemorrhage compared with initial conservative therapy. In conclusion, a lot of well-designed studies are needed to recommend appropriate surgical management in patients with acute ischemic and hemorrhagic stroke.