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Medical Steps Before Hemicraniectomy
- Prevent and treat malignant edema with BP and glucose control, hyperosmolar therapy, and consider glibenclamide trials.
- Use hypertonic saline to target serum sodium ~150–155 mmol/L in selected patients.
Recanalization Lowers Craniectomy Need
- Early hemicraniectomy saves lives in younger patients but often leaves significant disability.
- Recanalization reduces the need for hemicraniectomy by preventing large-core infarcts.
Control BP And Glucose Post-Reperfusion
- Monitor for hemorrhagic transformation after reperfusion and control BP and glucose to reduce risk.
- Tailor post-reperfusion BP: <180 mmHg after tPA, lower (≈140) after good recanalization.