Stroke management: decompressive hemicraniectomy
Substantive changes at this update
INTRODUCTION: Stroke is the third most common cause of death in most developed countries. A percentage of those deaths are due to proximal middle cerebral artery or internal carotid artery occlusion that lead to large infarcts, severe oedema, and subsequent death, particularly in young people. Hemicraniectomy is a procedure that reduces the intracranial pressure by providing more space to the swollen brain. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of decompressive hemicraniectomy in acute ischaemic stroke on mortality and subsequent disability and quality of life? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found eight studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following intervention: decompressive hemicraniectomy.