{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:10:39Z","timestamp":1778281839612,"version":"3.51.4"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Malignant middle cerebral artery (MCA) infarction is associated with high mortality due to massive cerebral edema and herniation. While decompressive craniectomy (DC) reduces mortality, it often results in severe disability and necessitates secondary cranioplasty. Alternatives such as ischemic core resection with immediate bone flap replacement (\u201ccorectomy\u201d) may provide internal decompression while avoiding secondary surgery.<\/jats:p>\n                  <jats:p>The aim of the study is to describe a single-center experience with ischemic core resection and immediate bone flap replacement in patients with malignant MCA infarction, and to compare outcomes with historical DC cohorts.<\/jats:p>\n                  <jats:p>We retrospectively reviewed seven consecutive patients (mean age 55.1 years) treated with core resection and immediate bone flap replacement for malignant MCA infarction between 2021 and 2025. Inclusion criteria included infarction \u22652\/3 of MCA territory, midline shift \u22655 mm, and MRI demonstrating a core &gt;50% of the ischemic stroke. The surgical technique involved a large craniotomy, resection of infarcted tissue guided by intraoperative assessment, and immediate cranial closure. Outcomes analyzed included in-hospital mortality, modified Rankin Scale (mRS) at discharge and at 3 months, complications, ICU stay, and reinterventions. A comparative analysis was conducted against the existing literature.<\/jats:p>\n                  <jats:p>All patients survived hospitalization (0% mortality). Median ICU stay was 3 days (range 0\u201310), and median total hospital stay was 30 days. No patient required reintervention or delayed cranioplasty. At discharge, one patient had mRS 1, one had mRS 3, four had mRS 4, and one had mRS 5. At 3 months, two patients achieved mRS \u22643 (28.5%). Compared with the literature, ICU stay was shorter (mean 3.7 vs. 7.5 days; p\u2009=\u20090.057), and functional outcome was comparable to that reported for DC (28.5% vs. 25\u201345% mRS \u22643). The rate of surgical reintervention was significantly lower (0\/7 vs. 5\/7; p\u2009=\u20090.0257).<\/jats:p>\n                  <jats:p>Core resection with immediate bone flap replacement may offer a safe and technically feasible alternative to DC in selected patients with malignant MCA infarction. This single-stage procedure was associated with no mortality, reduced ICU stay, and eliminated the need for cranioplasty, potentially lowering complication rates and overall surgical burden and costs. Although functional recovery was limited, outcomes were similar to those of conventional DC. These findings support further investigation of corectomy in prospective, controlled studies to better define its role in neurocritical care.<\/jats:p>","DOI":"10.1055\/s-0045-1814443","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T23:43:46Z","timestamp":1769211826000},"page":"310-319","source":"Crossref","is-referenced-by-count":0,"title":["Primary Ischemic Core Resection (Corectomy) with Immediate Bone Flap Replacement in Malignant Middle Cerebral Artery Infarction: A Case Series and Systematic Comparison with Decompressive Craniectomy Outcomes"],"prefix":"10.1055","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1857-219X","authenticated-orcid":false,"given":"Jorge","family":"Tabilo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Carmona","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Sfeir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Luis","family":"Cuevas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilda","family":"Parra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4113-9370","authenticated-orcid":false,"given":"Julio Garcia","family":"Molina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Abarca","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristobal","family":"Bravo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Salazar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filadelfo","family":"Normabuena","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Cerda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei F.","family":"Joaquim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital das Cl\u00ednicas, Universidade Estadual de Campinas, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1001\/archneur.1996.00550040037012","article-title":"\u2018Malignant\u2019 middle cerebral artery territory infarction: clinical course and prognostic signs","volume":"53","author":"W Hacke","year":"1996","journal-title":"Arch Neurol"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1161\/STROKEAHA.107.485235","article-title":"Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial)","volume":"38","author":"K Vahedi","year":"2007","journal-title":"Stroke"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/S1474-4422(09)70047-X","article-title":"Surgical decompression for space-occupying cerebral infarction (the HAMLET trial): a multicenter, open, randomized trial","volume":"8","author":"J Hofmeijer","year":"2009","journal-title":"Lancet Neurol"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1161\/STROKEAHA.107.485649","article-title":"Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY)","volume":"38","author":"E J\u00fcttler","year":"2007","journal-title":"Stroke"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S1474-4422(07)70036-4","article-title":"Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials","volume":"6","author":"K Vahedi","year":"2007","journal-title":"Lancet Neurol"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/ijs.12329","article-title":"Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review","volume":"10","author":"T van Middelaar","year":"2015","journal-title":"Int J Stroke"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1089\/neu.2010.1612","article-title":"Long-term complications of decompressive craniectomy for head injury","volume":"28","author":"S Honeybul","year":"2011","journal-title":"J Neurotrauma"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1056\/NEJMoa1311367","article-title":"Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke","volume":"370","author":"E J\u00fcttler","year":"2014","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.3389\/fneur.2019.01017","article-title":"Strokectomy and extensive cisternal CSF drain for acute management of malignant MCA infarction: technical note and case series","volume":"10","author":"G Pilloni","year":"2019","journal-title":"Front Neurol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00415-020-10358-9","article-title":"Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence","volume":"269","author":"S Moughal","year":"2022","journal-title":"J Neurol"},{"key":"ref11","first-page":"e280","article-title":"Immediate cranioplasty after decompressive craniectomy: results and complications","volume":"150","author":"L Tanrikulu","year":"2021","journal-title":"World Neurosurg"},{"issue":"06","key":"ref12","first-page":"898","article-title":"Timing of cranioplasty after decompressive craniectomy for trauma","volume":"80","author":"M P Stone","year":"2013","journal-title":"World Neurosurg"},{"issue":"03","key":"ref13","first-page":"215","article-title":"Early decompressive surgery beyond 48\u2009hours in malignant infarction of the MCA","volume":"6","author":"K Vahedi","year":"2007","journal-title":"Lancet Neurol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S1726-4901(09)70302-8","article-title":"Outcome and prognostic factors of decompressive hemicraniectomy in malignant middle cerebral artery infarction","volume":"70","author":"C C Chen","year":"2007","journal-title":"J Chin Med Assoc"},{"issue":"06","key":"ref15","first-page":"1503","article-title":"Early metabolic responses to experimental intracerebral hemorrhage: implications for cellular injury","volume":"37","author":"K R Wagner","year":"2006","journal-title":"Stroke"},{"issue":"06","key":"ref16","first-page":"1637","article-title":"Cost-effectiveness of decompressive craniectomy as a lifesaving rescue procedure for patients with severe traumatic brain injury","volume":"71","author":"K M Ho","year":"2011","journal-title":"J Trauma"},{"issue":"06","key":"ref17","first-page":"428","article-title":"Decompressive hemicraniectomy for malignant middle cerebral artery infarction: clinical outcome and radiographic features","volume":"20","author":"A Arac","year":"2011","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref18","first-page":"1847","article-title":"Strokectomy in malignant middle cerebral artery infarction: a 20-year experience from a tertiary center in Taiwan","volume":"8","author":"Y T Liu","year":"2023","journal-title":"J Surg"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1814443.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:56:21Z","timestamp":1778280981000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1814443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":18,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,5,8]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1814443","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"value":"1793-5482","type":"print"},{"value":"2248-9614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}