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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1814443
Research Article

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

Autor*innen

  • Jorge Tabilo 

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Pablo Carmona

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Felipe Sfeir

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Jose Luis Cuevas

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Pedro Castro

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Mario Rivera

    2   Department of Neurology, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Gilda Parra

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Julio Garcia Molina 

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Benjamin Abarca

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Cristobal Bravo

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Cristian Salazar

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Filadelfo Normabuena

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Jorge Cerda

    1   Department of Neurosurgery, Hospital de Puerto Montt, Puerto Montt, Los Lagos, Chile

  • Andrei F. Joaquim

    3   Department of Neurology, Hospital das Clínicas, Universidade Estadual de Campinas, São Paulo, Brazil
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Abstract

Background

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 (“corectomy”) may provide internal decompression while avoiding secondary surgery.

Objective

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.

Materials and Methods

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 ≥2/3 of MCA territory, midline shift ≥5 mm, and MRI demonstrating a core >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.

Results

All patients survived hospitalization (0% mortality). Median ICU stay was 3 days (range 0–10), 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 ≤3 (28.5%). Compared with the literature, ICU stay was shorter (mean 3.7 vs. 7.5 days; p = 0.057), and functional outcome was comparable to that reported for DC (28.5% vs. 25–45% mRS ≤3). The rate of surgical reintervention was significantly lower (0/7 vs. 5/7; p = 0.0257).

Conclusion

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.

Keywords

decompressive craniectomy - ischemic core resection - malignant middle cerebral artery - strokectomy - modified Rankin scale


Publikationsverlauf

Artikel online veröffentlicht:
23. Januar 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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