Craniectomy Combined with Rapid Internal Decompression in Massive Cerebral Infarction : Surgical Technique and Outcomes.

Objective: Massive cerebral infarction caused by middle cerebral artery infarction leads to extensive cerebral infarction in one hemisphere, resulting in swelling of the brain and further compression of surrounding normal brain tissue, ultimately leading to a complete cerebral infarction and a mortality rate of about 50-80% for patients. Although early decompressive craniectomy and partial internal decompression can reduce mortality rates, neurosurgeons should strive to achieve lower mortality rates in the face of patients' lives. This study introduces a surgical method with lower mortality rate, which is a rapid internal decompression technique for cerebral hemisphere resection through a flat bone window after decompressive craniectomy (DC) and partial temporal lobe resection.

Methods: From March 2022 to March 2024, 18 patients with extensive cerebral infarction underwent craniotomy and partial temporal lobectomy, craniectomy combined with rapid internal decompression (CCRID). Standard large bone flap craniotomy and anterior temporal lobe resection were performed. Circular electrocoagulation of the arachnoid membrane 1 cm inside the bone window, with sharp cutting, and then rapid resection of necrotic brain tissue outside the bone window (the height of the removed necrotic brain tissue is about 1-2 cm), while electrocoagulating the blood vessels from front to back along the direction of blood vessel formation. Place the drainage tube and intracranial pressure monitoring catheter for 1-2 days. Clinical outcomes were compared to 24 patients who underwent DC combined with partial temporal/frontal pole resection (DCPTR).

Results: The average age of 18 patients was 63 years. The mean cerebral hemisphere resection time was 6.8 minutes with total surgery averaging 2.82 hours. Postoperative ICP averaged 4 mmHg, and the midline shifted back by 0.45 cm. At 3 months, there was one intracerebral hemorrhage, no infections, and a mortality rate of 11.1%. The mean modified Rankin scale score was 4.45. Compared to DCPTR, CCRID showed similar midline shift, shorter surgery time, and lower mortality.

Conclusion: CCRID may represent a viable decompression technique for patients with massive hemispheric infarctions, warranting further consideration for future applications.