Neurosurgery for acute ischaemic stroke

Because of the effects of cerebral oedema, an extensive hemispheric infarction is fatal in over 80% of patients. In a few highly selected patients (ie aged 18 to 60 years with extensive infarcts), hemicraniectomy saves lives and reduces disability. Hemicraniectomy should be considered within 48 hours of stroke onset for these patients—the decision should involve stroke specialists and neurosurgeons from specialised stroke units.

Oedema surrounding large cerebellar infarcts is also associated with high mortality. Ventricular drainage (to relieve acute hydrocephalus) and posterior fossa decompression are treatments of choice for large space-occupying cerebellar infarcts.