External ventricular drainage in complete infarction of the medial cerebral artery

• Published in: Revista de neurologiá Vol. 36; no. 6; pp. 526 - 529
• Main Authors: Aladro, Y, Muñoz-Fernández, C, Alemany-Rodríguez, M J, Morera-Molina, J, Lubillo-Montenegro, S
• Format: Journal Article
• Language: Spanish
• Published: Spain 16-03-2003
• Subjects: Adult; Decompression, Surgical; Drainage; Female; Humans; Infarction, Middle Cerebral Artery - pathology; Infarction, Middle Cerebral Artery - surgery; Intracranial Pressure; Lateral Ventricles - surgery; Oxygen - metabolism; Tomography, X-Ray Computed
• ISSN: 0210-0010

Increased intracranial pressure (ICP) due to complete middle cerebral artery territory infarction does not respond to medical treatment and is often followed by transtentorial herniation and death. Some authors have reported good outcome after performing decompressive hemicraniectomy in this condition. The potential clinical benefit of intracranial pressure reduction by means of an external ventriculostomy in such cases is unknown.
The present paper discusses the case of a 33 year old female who suffered a massive infarction of the territory of the right middle cerebral artery with transtentorial herniation and left lateral ventricular dilation who rapidly improved after performing external ventriculostomy without hemicraniectomy. The brain tissue partial oxygen pressure (PtiO2) was monitored in the left frontal lobe and a fair correlation with clinical events was found.
External ventricular drainage without hemicraniectomy could be lifesaving in some case of massive ( malignant ) hemispheric infarction and more studies on this therapeutic approach would be needed. Monitoring PtiO2 in these patients would be useful in adopting therapeutic decisions.