Malignant Edema

Large middle cerebral artery (MCA) and cerebellar strokes can cause rapid neurological deterioration and death from edema, mass effect, and herniation. Hemicraniectomy in select patients with malignant MCA syndromes is life-saving, but patients are often left with significant disability. Younger patients may derive the most benefit from hemicraniectomy. Cerebellar strokes can also cause obstructive hydrocephalus, which may exacerbate herniation and brainstem compromise. Surgical decompression through suboccipital craniectomy relieves posterior fossa pressure and reduces mortality in these patients.