Feasibility of infarctectomy in cases of malignant cerebral infarction in the middle cerebral artery territory

Introduction. Malignant middle cerebral artery (MCA) infarction is associated with the inevitable growth of cerebral hemisphere edema ultimately resulting in temporal transtentorial herniation. Decompressive hemicraniectomy (DCH) is the operation of choice for Malignant MCA; however, it does not prevent the predictable and rapidly progressive increase in cerebral hemisphere edema during the postoperative period, followed by the development of intracranial hypertension. Therefore, several authors suggest supplementing DHC with infarctectomy to improve surgical outcomes. At the same time, some researchers consider infarctectomy pointless.

Objective: to determine the feasibility of infarctectomy in patients with malignant MCA.

Material and methods. 9 patients aged 47–68 years (mean 58.2 ± 2.2 years) underwent DHC with additional infarctectomy and tentoriotomy. Morphological examination of biopsy materials from the anterior part of the temporal lobe was performed for all patients.

Results. Morphological examination of the resected anterior part of the temporal lobe confirmed the presence of irreversible changes in the brain tissue in all patients. The results of follow-up computed tomography of the brain revealed porencephalic and signs of resorption of necrotized brain tissue of the cerebral hemisphere with its replacement by cerebrospinal fluid.

Conclusion. Irreversible morphological changes in the resected brain tissue and follow-up computed tomography data confirm the feasibility of infarctectomy in cases of malignant cerebral infarction in the territory supplied by the middle cerebral artery.

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