Surgical Management of Strok

Despite improvements of treatment, hemispheric strokes retain a strikingly high mortality due to malignant edema and herniation. The pathogenesis of ischemiccerebral edema is steered by disruption of ionic homeostasis in the damaged tissue. Significant effort has been made to identify potential medical therapies targetingedema formation with promising results. To date, decompressive craniectomy remains the therapy with the most robust impact on mortality. Historically, patientselection for surgical treatment of malignant supratentorial strokes has focused on a strict age cutoff and hemispheric dominance. Recent evidence supports a significantmortality and morbidity benefit in elderly population, although the impact in morbidity is modest. Careful patient selection for surgical treatment in conjunctionwith comprehensive neurocritical care and inclusion of family in the educated decision making process remain the mainstay of care for such shattering disease.