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0883073808314960v1
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First published on April 10, 2008, doi:10.1177/0883073808314960

Journal of Child Neurology 2008;23:889.

A more recent version of this article appeared on August 1, 2008

Article

Decompressive Hemicraniectomy in Children With Severe Ischemic Stroke and Life-Threatening Cerebral Edema

Vijay Ramaswamy, MD1, Vivek Mehta, MD2, Mary Bauman, NP3, Lawrence Richer, MD1, Patti Massicotte, MD3, and Jerome Y. Yager, MD, FRCPC1*

1 Department of Pediatrics and Section of Pediatric Neurosciences, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
2 Department of Neurosurgery, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
3 Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada

* To whom correspondence should be addressed. E-mail: jyager{at}ualberta.ca.


  Abstract
Decompressive hemicraniectomy has been discussed as a treatment option that increases survival in adults with malignant stroke. This approach has not been studied extensively in children. From a prospective cohort, we identified 4 children who underwent decompressive hemicraniectomy for malignant infarctions with life-threatening cerebral edema within 72 hours of their stroke. All 4 children had different causes for their stroke and experienced severe cerebral edema with increasing intracranial pressure and an impending fatal outcome. Despite massive cerebral infarction, all patients were ambulant and able to speak at the time of follow-up. Although a limited experience, decompressive hemicraniectomy is a lifesaving approach for malignant stroke in children.


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