Decompression Craniotomy in the Complex Intensive Therapy of Malignant Forms of Massive Ischemic Stroke
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The course of massive ischemic stroke (MIS) was studied in 105 patients. The results of investigations and intensive treatment identified a group of patients in which the course of MIS was benign, with no development of dislocation syndrome, and a group with a malignant course, with development of hemisphere cerebral edema and further transtentorial impact. Risk factors for the development of the malignant form of MIS and lethal outcomes were identified: lateral dislocation of greater than 7 mm, volume of ischemia greater than 70% of the frontal and parietal lobes and more than 80% of the temporal lobe, and impairment to the level of consciousness to moderate coma and worse. These were used to form a group of patients who underwent decompression craniotomy on the side of the lesioned hemisphere. This decreased lethality more than twofold compared with patients treated conservatively.
Keywordsmassive ischemic stroke risk factors brain dislocation decompression craniotomy
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