Leonhardt Georg, Wilhelm Hans, Doerfler Arnd, Ehrenfeld Christiane E, Schoch Beate, Rauhut Friedhelm, Hufnagel Andreas, Diener Hans Christoph
Klinik und Poliklinik für Neurologie, Martin-Luther-Universität, Halle-Wittenberg, 06097 Halle/Saale, Germany.
J Neurol. 2002 Oct;249(10):1433-40. doi: 10.1007/s00415-002-0875-1.
The purpose of this study was to analyse in detail the functional outcome and the neuropsychological deficits in patients with space-occupying infarction of the non-dominant hemisphere one year after surgery.
Postoperative complications and retrospective consent to surgery were assessed in a semi-structured interview in 26 patients. Functional outcome was measured with the Barthel-Index (BI) and Rankin-Scale. Neuropsychological tests in 14 patients focused on visuo-spatial and visuo-constructive abilities, attention, spatial span and self-rated mood.
The one-year survival rate was 69 % (18 of 26). The functional outcome was good (BI >/= 90) in 3 patients, fairly good (BI 75-85) in 6, moderate (BI 30-70) in 6, and poor (BI 0-25) in 3 patients. Age was an independent predictor of outcome, patients above 52 years had a BI of 50 or below. Neuropsychological tests (14 of 18) showed profound attention deficits in all patients, and visuo-spatial and visuo-constructive deficits in patients with lower formal education. Retrospectively, 4 of 18 patients would not give consent to surgery again, mostly because of the bad quality of life postoperatively.
Older patients do not seem to benefit from decompressive hemicraniectomy; more than half of the surviving younger patients have a good outcome and live independently. Attention deficits are prominent in all patients; visuo-spatial and constructive deficits are less pronounced in patients with higher formal education. Retrospective agreement to decompressive hemicraniectomy is high in patients with good functional outcome.
本研究旨在详细分析非优势半球占位性梗死患者术后一年的功能转归及神经心理缺陷。
通过半结构化访谈评估26例患者的术后并发症及对手术的回顾性同意情况。采用Barthel指数（BI）和Rankin量表测量功能转归。对14例患者进行神经心理测试，重点关注视觉空间和视觉构建能力、注意力、空间跨度及自评情绪。
一年生存率为69%（26例中的18例）。3例患者功能转归良好（BI≥90），6例相当好（BI 75 - 85），6例中等（BI 30 - 70），3例差（BI 0 - 25）。年龄是转归的独立预测因素，52岁以上患者的BI为50或更低。神经心理测试（18例中的14例）显示所有患者均存在明显的注意力缺陷，低学历患者存在视觉空间和视觉构建缺陷。回顾性分析，18例患者中有4例不会再次同意手术，主要是因为术后生活质量差。
老年患者似乎无法从减压性颅骨切除术获益；超过半数存活的年轻患者转归良好且能独立生活。所有患者均存在明显的注意力缺陷；高学历患者的视觉空间和构建缺陷不那么明显。功能转归良好的患者对减压性颅骨切除术的回顾性同意率较高。
