Decompressive Craniectomy for Bilateral Anterior Cerebral Artery Infarction: Case Report and Brief Literature Review

Decompressive craniectomy for “malignant” bilateral anterior cerebral artery infarction (BACAI) has not been reported in the literature. Here we present such a case in relation to its presentation, surgical management, outcome and anatomical basis.
Bifronto-temporal decompressive craniectomy was performed on a patient diagnosed with acute infarction in bilateral anterior cerebral artery (ACA) territories and rapidly deteriorating having clinical and radiological signs of tonsillar herniation. Patient sustained several motor disabilities at sixth week following surgery, however, post-operative CT showed reversing of the “conning” with spaced basal cisterns which was compatible with clinical improvement.