Background and Purpose:Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear.Methods:We retrospectively reviewed all COVID-19–positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema.Results:Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases.Conclusions:COVID-19–positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.

中文翻译：

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COVID-19和减压半颅切除术治疗急性缺血性中风。

背景与目的：已证明年轻的恶性脑水肿患者可从早期减压半脑切除术中受益。目前尚不清楚2019年合并冠状病毒病（COVID-19）的影响以及该因素如何影响手术决策。方法：我们回顾性研究了神经科学重症监护病房因恶性水肿入院的所有COVID-19阳性患者。监控。计算机断层扫描显像的大脑中动脉受累> 50％的患者被认为有恶性水肿的风险。结果：有7例患者入院以监测其死亡4例。死亡原因与COVID-19并发症有关，在典型的恶性脑肿胀窗口后的重症监护病房病程很早和几天就可以看到。3例接受了手术，1例患者因心力衰竭而死亡。其他2例都取得了良好的疗效。结论：COVID-19阳性的大半球性卒中患者在减压半颅切除术中可以取得良好的疗效。不应单独使用COVID-19阳性试验来将患者排除在可能挽救生命的程序之外。