Chen H J, Lee T C, Wei C P
Department of Surgery, Chang Gung Medical School and Hospital, Kaohsiung, Taiwan, Republic of China.
Stroke. 1992 Jul;23(7):957-61. doi: 10.1161/01.str.23.7.957.
We present an anecdotal series of 11 patients without past history of stroke with progressive neurological deterioration while on medical therapy for large cerebellar infarctions. Clinical signs of brain stem compression developed in these patients. Computerized tomography of the head confirmed mass effect from brain edema. It was the clinical judgment of the neurologists and neurosurgeons that each of these 11 patients would expire without surgical intervention.
All 11 patients (seven men, four women; mean age, 54 years) were treated with suboccipital craniectomy for decompression and temporary ventriculostomy for cerebrospinal fluid pressure monitoring and drainage.
Seven patients demonstrated neurological improvement on the first postoperative day. Two patients returned to their previous jobs 3 months after surgery. The Barthel Index indicated that six individuals were functioning with minimal assistance within a follow-up period of 16-60 months. The remaining three were functionally dependent. No mortality was noted in this series.
These results suggest that decompressive suboccipital craniectomy may be an effective, lifesaving procedure for malignant cerebellar edema after a large infarction.
我们报道了11例既往无卒中病史的患者，这些患者在接受大型小脑梗死的药物治疗时出现进行性神经功能恶化。这些患者出现了脑干受压的临床体征。头颅计算机断层扫描证实了脑水肿引起的占位效应。神经科医生和神经外科医生根据临床判断认为，这11例患者若不进行手术干预均会死亡。
所有11例患者（7例男性，4例女性；平均年龄54岁）均接受了枕下颅骨切除术以进行减压，并进行了临时脑室造瘘术以监测和引流脑脊液压力。
7例患者在术后第一天神经功能有改善。2例患者在术后3个月恢复了之前的工作。巴氏指数表明，在16至60个月的随访期内，6例患者在极少帮助下能够自理。其余3例患者功能依赖。本系列中未观察到死亡病例。
这些结果表明，枕下减压颅骨切除术可能是治疗大型梗死后恶性小脑水肿的一种有效、挽救生命的手术。
