Gupta Rishi, Connolly E Sander, Mayer Stephan, Elkind Mitchell S V
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Stroke. 2004 Feb;35(2):539-43. doi: 10.1161/01.STR.0000109772.64650.18. Epub 2004 Jan 5.
Hemicraniectomy and durotomy have been proposed in many small series to relieve intracranial hypertension and tissue shifts in patients with large hemispheric infarcts, thereby preventing death from herniation. Our objective was to review the literature to identify patients most likely to benefit from hemicraniectomy.
All available individual cases from the English literature were reviewed and analyzed to determine whether age, vascular territory of infarction, side of infarction, reported time to surgery, and signs of herniation predict outcome in patients after hemicraniectomy. All studies included were retrospective and uncontrolled; there were no randomized controlled trials.
Of 15 studies screened, 12 studies describing 129 patients met the criteria for analysis; 9 patients treated at our institution were added, for a total of 138 patients. After a minimum follow-up of 4 months, 10 patients (7%) were functionally independent, 48 (35%) were mildly to moderately disabled, and 80 (58%) died or were severely disabled. Of 75 patients who were >50 years of age, 80% were dead or severely disabled compared with 32% of 63 patients <or=50 years of age (P<0.00001). The timing of surgery, hemisphere infarcted, presence of signs of herniation before surgery, and involvement of other vascular territories did not significantly affect outcome.
Age may be a crucial factor in predicting functional outcome after hemicraniectomy in patients with large middle cerebral artery territory infarction.
许多小规模研究提出，对于大面积半球梗死患者，实施去骨瓣减压术和硬脑膜切开术可缓解颅内高压和组织移位，从而预防因脑疝导致的死亡。我们的目的是回顾文献，以确定最可能从去骨瓣减压术中获益的患者。
对英文文献中所有可得的个体病例进行回顾和分析，以确定年龄、梗死的血管区域、梗死侧、报告的手术时间以及脑疝体征是否可预测去骨瓣减压术后患者的预后。纳入的所有研究均为回顾性且非对照研究；无随机对照试验。
在筛选的15项研究中，12项描述了129例患者的研究符合分析标准；增加了我院治疗的9例患者，共计138例患者。在至少随访4个月后，10例患者（7%）功能独立，48例（35%）轻度至中度残疾，80例（58%）死亡或严重残疾。75例年龄>50岁的患者中，80%死亡或严重残疾，而63例年龄≤50岁的患者中这一比例为32%（P<0.00001）。手术时机、梗死半球、术前脑疝体征的存在以及其他血管区域的受累情况对预后无显著影响。
年龄可能是预测大脑中动脉区域大面积梗死患者去骨瓣减压术后功能预后的关键因素。
