Vol. 29 No. 1 (2025)
CASE REPORTS

Efficacy of decompressive hemicraniectomy supplemented by infarctectomy and tentoriotomy in surgical treatment of malignant middle cerebral artery infarction: a case series

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  • Salah M.M. Sehweil,
  • A.A. Sufianov,
  • Z.A. Goncharova,
  • E.Yu. Kirichenko,
  • A.K. Logvinov
Salah M.M. Sehweil
Rostov State Medical University, Ministry of Health of the Russian Federation, Rostov-on-Don
Bio
A.A. Sufianov
Federal Centre of Neurosurgery, Ministry of Health of the Russian Federation, Tyumen
Z.A. Goncharova
Rostov State Medical University, Ministry of Health of the Russian Federation, Rostov-on-Don
E.Yu. Kirichenko
Don State Technical University, Rostov-on-Don
A.K. Logvinov
Southern Federal University, Rostov-on-Don
DOI: https://doi.org/10.21688/1681-3472-2025-1-89-98

Published 2025-04-28

Keywords

  • Brain Edema,
  • Case Reports,
  • Ischemic Stroke

How to Cite

Sehweil, S. M., Sufianov, A., Goncharova, Z., Kirichenko, E., & Logvinov, A. (2025). Efficacy of decompressive hemicraniectomy supplemented by infarctectomy and tentoriotomy in surgical treatment of malignant middle cerebral artery infarction: a case series. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 29(1), 89–98. https://doi.org/10.21688/1681-3472-2025-1-89-98

Copyright (c) 2025 Sehweil Salah M.M., Sufianov A.A., Goncharova Z.A., Kirichenko E.Yu., Logvinov A.K.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Objective: The study aimed to assess the efficacy of decompressive hemicraniectomy supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy in the treatment of malignant cerebral infarction (MCI) in the middle cerebral artery (MCA) territory in a series of 7 cases.

Methods: We have assessed the results of surgical treatment of 7 patients with MCI in the MCA territory. Mean age of the patients was 57.4 ± 2.8 years (from 47 to 68 years). All patients underwent decompressive hemicraniectomy (DHC), supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy. In order to assess the safety of resection and the absence of a risk of developing additional neurological deficit, a morphological investigation of the resected ischemic brain tissue of the anterior temporal lobe was performed.

Results: During the dynamic observation the maximum severity score according to the National Institutes of Health Stroke Scale amounted to 35 points. Among patients, underwent decompressive hemicraniectomy supplemented by resection of the ischemic anterior temporal lobe and tentoriotomy, no cases of death were registered in the postoperative period. Morphological examination of the biopsy material of the resected ischemic anterior temporal lobe confirmed the emergence of irreversible changes in brain tissue.

Conclusion: An analysis of the results of 7 investigated cases showed the efficacy of decompressive hemicraniectomy, supplemented by resection of the ischemic anterior part of the temporal lobe and tentoriotomy, in the treatment of MCI in the MCA infarction, and a decrease in the level of postoperative mortality. The approach presented requires further continuation of the study.

Received 8 October 2024. Revised 24 December 2024. Accepted 25 December 2024.

Informed consent
Informed consent was obtained for the publication and use of medical data for scientific purposes in patients who were admitted with a clear mind. If, upon admission, the patient had a neurological deficit in the form of aphasic disorders or had a depressed level of consciousness, informed consent was obtained from close relatives.

Funding
The study did not have sponsorship.

Conflict of interest
The authors declare no conflict of interest.

Contribution of the authors
Literature review: Salah M.M. Sehweil, E.Yu. Kirichenko
Drafting the article: Z.A. Goncharova, Salah M.M. Sehweil
Critical revision of the article: A.K. Logvinov
Surgical treatment: Salah M.M. Sehweil
Final approval of the version to be published: Salah M.M. Sehweil, A.A. Sufianov, Z.A. Goncharova, E.Yu. Kirichenko, A.K. Logvinov

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