Asian journal of neurosurgery
April 29, 2026 · via Europe PMC
Decompressive Craniectomy in Ischemic Stroke: Neurosurgical Perspectives on Patient Outcomes and Psychological Impact on Family.
Gupta K, Singh S, Mani A.
AI summary — for doctors, generated from the abstract only
This narrative review frames decompressive craniectomy as turning a frequently fatal malignant MCA infarction into a survivable but often disabling condition.
What was studied
Narrative review (1995 to 2025) of randomized trials, cohorts, meta-analyses and caregiver research on decompressive craniectomy for ischemic stroke, with endpoints of survival, mRS distribution, caregiver burden and neurorehabilitation.
Key findings
- Malignant MCA infarction affects 1 to 10% of ischemic stroke patients and carries 40 to 80% mortality under best medical therapy
- The authors conclude DC converts a previously fatal event into survivable but often disabling outcomes
- They call for refining patient selection, especially over age 60, structured family support and advanced rehabilitation
Clinical relevance
Supports shared decision-making that balances survival with quality of life and caregiver well-being.
Who should care
Limitations
The results section is cut off in the abstract, so the specific outcome figures are not available here. It is a narrative review without pooled analysis.
Surgery improves survival but disability is common; discuss expected function and family impact openly.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Malignant middle cerebral artery infarction afflicts 1 to 10% of ischemic stroke patients and carries 40 to 80% mortality under best medical therapy.
Objective
To synthesize neurosurgical evidence, family-centered psychosocial data, and future research priorities concerning decompressive craniectomy (DC) for ischemic stroke.
Materials and methods
A narrative review of randomized trials, cohort studies, meta-analyses, and caregiver research (1995-2025) was undertaken, adhering to the Indian Journal of Neurosurgery guidelines. Primary endpoints were survival, modified Rankin Scale (mRS) distribution, caregiver psychological burden, and emerging neurorehabilitation insights.
Results
Early DC (<48 hours) reduces mortality by 41 to 50% versus medical treatment alone, with a number-needed-to-treat of 2 to 3. Survival gains are offset by higher rates of severe disability (mRS: 4-5) in 27 to 40% of cases. Patients < 60 years demonstrate twice the odds of achieving mRS of 0 to 3 at long-term follow-up compared with older cohorts. Complication rates reach 54%, dominated by hemorrhage, hydrocephalus, and sinking-flap syndrome. Up to 75% of caregivers report clinically significant anxiety or depression, and 17 to 28% develop posttraumatic stress symptoms. Neuroplastic recovery mechanisms-synaptogenesis, peri-infarct network re-engagement, and restored cerebrospinal fluid dynamics after cranioplasty-permit functional gains beyond 6 months, challenging traditional prognostic pessimism.
Conclusion
DC transforms a previously fatal event into survivable-but often disabling-outcomes. Shared decision-making must balance survival with quality of life and caregiver well-being. Future work should refine patient selection (especially > 60 years), integrate structured family support, and exploit advanced rehabilitation technologies to convert survival benefits into meaningful functional recovery.
DOI
10.1055/s-0046-1820439
PMID
42857508
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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