RCP Guidance 2016 Patients with middle cerebral artery (MCA) infarction who meet the criteria below should be considered for decompressive hemicraniectomy. Patients should be referred to neurosurgery within 24 hours of stroke onset and treated within 48 hours of stroke onset:
Neurosurgical Trials Authors Outcome Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial Lancet Neurol. 2009 Apr;8(4):326-33
HAMLET investigators Surgical decompression reduces case fatality and poor outcome in patients with space-occupying infarctions who are treated within 48 h of stroke onset. There is no evidence that this operation improves functional outcome when it is delayed for up to 96 h after stroke onset. The decision to perform the operation should depend on the emphasis patients and relatives attribute to survival and dependency.
Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY) Stroke 2007;38:2518-2525
DESTINY Study Group
DESTINY showed that hemicraniectomy reduces mortality in large hemispheric stroke. With 32 patients included, the primary end point failed to demonstrate statistical superiority of hemicraniectomy, and the projected sample size was calculated to 188 patients. Despite this failure to meet the primary end point, the steering committee decided to terminate the trial in light of the results of the joint analysis of the 3 European hemicraniectomy trials.
Hemicraniectomy in Older Patients with Extensive Middle-Cerebral-Artery Stroke N Engl J Med 2014; 370:1091-1100
DESTINY II Investigators
Hemicraniectomy increased survival without severe disability among patients > 60 years of age with a malignant MCA Infarction. The majority of survivors required assistance with most bodily needs. DESTINY II Current Controlled Trials number,