What is the recommendation for patients >60 years of age who deteriorate neurologically within 48 hours from brain swelling associated with unilateral MCA infarctions despite medical therapy?
Decompressive craniectomy with dural expansion may be considered. There is evidence that patients >60 years of age can have a reduction in mortality of 50% when decompressive craniectomy for malignant MCA infarction is performed within 48 hours of stroke onset. However, functional outcomes in elderly patients seem to be worse than those in patients <60 years of age.