Decompressive Hemicraniectomy With Duraplasty: A Treatment for Large-Volume Ischemic Stroke

Janice Tazbir; Maureen T. Marthaler; Cheryl Moredich; Patricia Keresztes


J Neurosci Nurs. 2005;37(4):194-199. 

In This Article

Abstract and Introduction

Increased intracranial pressure (ICP) is a cause of death and disability in neurological patients. Patients experiencing malignant stroke of the middle cerebral artery (MCA) have a high mortality related to cerebral edema, increased ICP, and subsequent cerebral herniation. Decompressive hemicraniectomy with duraplasty is a surgical option for those experiencing large volume MCA stroke. When decompressive hemicraniectomy with duraplasty is performed, functional outcomes improve if the MCA stroke candidate is younger, the onset of increased ICP occurred less than 24 hours before surgery, and surgery is performed before clinical signs of herniation syndrome occur. The level of care required for these patients makes nursing care challenging.

Cerebrovascular disease is the third most prevalent cause of death in the United States, behind cardiovascular disease and cancer (CDC, 2002). Ischemic stroke occurs every 45 seconds, killing someone every 3 minutes (AHA, 2004). While prevention is the best answer to this problem, providing care for those who experience ischemic stroke is a monumental task. In the past decade, there have been advances in stroke care, including the use of thrombolytic therapy. Nonetheless, patients with large ischemic strokes continue to have high mortality and morbidity rates. Decompressive hemicraniectomy with duraplasty (DHWD) is a treatment modality for patients who experience large ischemic strokes with a consequent rise in intracranial pressure (ICP). This article presents a summary of diagnostic and clinical indicators for decompressive hemicraniectomy and highlights nursing care for increased ICP and the DHWD patient.