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<p>Decompressive hemicraniectomy (DHC) is a life-saving intervention in malignant middle cerebral artery (mMCA) infarction. However, landmark randomized trials excluded cases with hemorrhagic transformation (HT), a complication affecting up to 42% of patients. This survey aimed to characterize international neurosurgical practices regarding DHC in patients with mMCA infarction with secondary HT, focusing on decision-making, surgical indications, and perioperative strategies. An international, web-based 14-item survey was distributed via Google Forms® from October to December 2024. The survey explored institutional characteristics, case volume, use of standardized protocols, contraindications, and supportive therapies for DHC in mMCA infarction with HT. A total of 147 responses were analyzed, with 75% of respondents from academic hospitals and 76% being neurosurgical consultants. DHC was routinely performed for mMCA infarction by 92% of participants. Among those performing DHC in HT, 77% acknowledged that major RCTs had excluded such patients. Half considered the procedure lifesaving despite the lack of high-quality evidence. Only 39% used classification systems to quantify HT severity. This international survey reveals that many neurosurgical centers extrapolate DHC indications from mMCA infarction to cases with HT despite the lack of trial data. This reflects the need for prospective studies and standardized guidelines to improve patient selection and outcomes.</p>

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Surgical practices in decompressive hemicraniectomy for malignant middle cerebral artery infarction with hemorrhagic transformation: results from an international survey

  • 期刊论文

  • 发表日期：

    2026年2月10日

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  • Beate Kranawetter,
  • Tammam Abboud,
  • Veit Rohde,
  • Silvia Hernández-Durán

摘要

Decompressive hemicraniectomy (DHC) is a life-saving intervention in malignant middle cerebral artery (mMCA) infarction. However, landmark randomized trials excluded cases with hemorrhagic transformation (HT), a complication affecting up to 42% of patients. This survey aimed to characterize international neurosurgical practices regarding DHC in patients with mMCA infarction with secondary HT, focusing on decision-making, surgical indications, and perioperative strategies. An international, web-based 14-item survey was distributed via Google Forms® from October to December 2024. The survey explored institutional characteristics, case volume, use of standardized protocols, contraindications, and supportive therapies for DHC in mMCA infarction with HT. A total of 147 responses were analyzed, with 75% of respondents from academic hospitals and 76% being neurosurgical consultants. DHC was routinely performed for mMCA infarction by 92% of participants. Among those performing DHC in HT, 77% acknowledged that major RCTs had excluded such patients. Half considered the procedure lifesaving despite the lack of high-quality evidence. Only 39% used classification systems to quantify HT severity. This international survey reveals that many neurosurgical centers extrapolate DHC indications from mMCA infarction to cases with HT despite the lack of trial data. This reflects the need for prospective studies and standardized guidelines to improve patient selection and outcomes.