Surgery of Cerebral Ischemia: State of the Art for the Supratentorial Region

The acute occlusion of the internal carotid or middle cerebral arteries leads to a severe brain swelling and to a malignant, often fatal syndrome. The aim of this paper is to assess the current knowledge about such a dramatic condition and to review the role of surgical indication in these patients. Decompressive hemicraniectomy keeps being a valid option, with proper timing in accurately selected patients, because entails a higher overall survival with a chance to also reduce the amount of parenchymal damage around the ischemic core.