alexa Decompressive Hemicraniectomy Remains a Physician?s Individual Decision
ISSN: 2155-9562

Journal of Neurology & Neurophysiology
Open Access

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Case Report

Decompressive Hemicraniectomy Remains a Physician?s Individual Decision

Catharina Keller*, Henning Stetefeld*

Universitätsklinikum Köln, Klinik für Neurologie, Kerpenerstrasse 62, 50924 Köln, Germany

Corresponding Authors:
Catharina Keller
Henning Stetefeld Department of Neurology
University Hospital Cologne
Kerpener Str. 62, D-50937 Cologne, Germany
Tel: +49-221-478-4029
Fax: +49-221-478-6454
E-mail: [email protected]


Dr. Henning Stetefeld
Department of Neurology
University Hospital Cologne
Kerpener Str. 62, D-50937 Cologne, Germany
Tel: +49 221 4784029
Fax: +49 221 478 6454
E-mail: [email protected]

Received date: May 20, 2014; Accepted dat: May 28, 2014; Published date: June 03, 2014

Citation: Keller C, Stetefeld H (2014) Decompressive Hemicraniectomy Remains a Physician’s Individual Decision. J Neurol Neurophysiol 5:211. doi:10.4172/2155-9562.1000211

Copyright: © 2014 Keller C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Although the latest trials (DESTINY, DESTINY II, HAMLET, DECIMAL) have provided evidence that
decompressive hemicraniectomy in malignant MCA infarction (MMI) can improve survival rates and neurological
outcomes, the decision for or against the procedure remains challenging in respect of the inclusion and exclusion
criteria, such as the definition of MMI, severity of symptoms at stroke onset and neuroimaging findings.
This report focuses on a young patient who suffered an MMI of the right hemisphere. Because of a rapid
deterioration in the clinical symptoms, we decided to perform an early decompressive hemicraniectomy after 24h.
The patient survived without any complications, and with a favourable outcome (mRS 1).
The case shows that young patients in particular can have a remarkable potential for full recovery after an MMI,
and that the benefits of surgery outweigh the risks, provided that 1) the hemicraniectomy is performed promptly
(after careful consideration of whether brain swelling might occur soon after MMI), and 2) the elective brain territories
have not yet been affected.


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