{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:49:24Z","timestamp":1791589764041,"version":"4.3.4"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"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":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Malignant middle cerebral artery infarction afflicts 1 to 10% of ischemic stroke patients and carries 40 to 80% mortality under best medical therapy.<\/jats:p>\n                  <jats:p>To synthesize neurosurgical evidence, family-centered psychosocial data, and future research priorities concerning decompressive craniectomy (DC) for ischemic stroke.<\/jats:p>\n                  <jats:p>A narrative review of randomized trials, cohort studies, meta-analyses, and caregiver research (1995\u20132025) was undertaken, adhering to the Indian Journal of Neurosurgery guidelines. Primary endpoints were survival, modified Rankin Scale (mRS) distribution, caregiver psychological burden, and emerging neurorehabilitation insights.<\/jats:p>\n                  <jats:p>Early DC (&lt;48\u2009hours) reduces mortality by 41 to 50% versus medical treatment alone, with a number-needed-to-treat of 2 to 3. Survival gains are offset by higher rates of severe disability (mRS: 4\u20135) in 27 to 40% of cases. Patients\u2009&lt;\u200960 years demonstrate twice the odds of achieving mRS of 0 to 3 at long-term follow-up compared with older cohorts. Complication rates reach 54%, dominated by hemorrhage, hydrocephalus, and sinking-flap syndrome. Up to 75% of caregivers report clinically significant anxiety or depression, and 17 to 28% develop posttraumatic stress symptoms. Neuroplastic recovery mechanisms\u2014synaptogenesis, peri-infarct network re-engagement, and restored cerebrospinal fluid dynamics after cranioplasty\u2014permit functional gains beyond 6 months, challenging traditional prognostic pessimism.<\/jats:p>\n                  <jats:p>DC transforms a previously fatal event into survivable\u2014but often disabling\u2014outcomes. Shared decision-making must balance survival with quality of life and caregiver well-being. Future work should refine patient selection (especially\u2009&gt;\u200960 years), integrate structured family support, and exploit advanced rehabilitation technologies to convert survival benefits into meaningful functional recovery.<\/jats:p>","DOI":"10.1055\/s-0046-1820439","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:25:48Z","timestamp":1777526748000},"page":"776-784","source":"Crossref","is-referenced-by-count":0,"title":["Decompressive Craniectomy in Ischemic Stroke: Neurosurgical Perspectives on Patient Outcomes and Psychological Impact on Family"],"prefix":"10.1055","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3272-536X","authenticated-orcid":false,"given":"Kanav","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivanya","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Oncoanesthesia and Palliative Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Mani","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.ncl.2021.11.009","article-title":"Decompressive craniectomy for stroke: who, when, and how","volume":"40","author":"G J Cannarsa","year":"2022","journal-title":"Neurol Clin"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.3389\/fneur.2018.01119","article-title":"Role of decompressive craniectomy in ischemic stroke","volume":"9","author":"L P Pallesen","year":"2019","journal-title":"Front Neurol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s11940-009-0014-8","article-title":"Decompressive hemicraniectomy for malignant hemispheric infarction","volume":"11","author":"K Vahedi","year":"2009","journal-title":"Curr Treat Options Neurol"},{"issue":"02","key":"ref4","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":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.4103\/1793-5482.161191","article-title":"Decompressive craniectomy in malignant middle cerebral artery infarct: an institutional experience","volume":"10","author":"H Bansal","year":"2015","journal-title":"Asian J Neurosurg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1385\/NCC:3:3:216","article-title":"Neurological recovery after decompressive craniectomy for massive ischemic stroke","volume":"3","author":"A Cheung","year":"2005","journal-title":"Neurocrit Care"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"E318","DOI":"10.1093\/neuros\/nyz522","article-title":"Outcome after decompressive craniectomy for middle cerebral artery infarction: timing of the intervention","volume":"86","author":"T Goedemans","year":"2020","journal-title":"Neurosurgery"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1161\/01.STR.26.2.259","article-title":"Decompressive craniectomy for cerebral infarction. 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