Chen Chun-Chung, Cho Der-Yang, Tsai Shu-Chiu
Department of Neurosurgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung, 404, Taiwan.
J Clin Neurosci. 2007 Apr;14(4):317-21. doi: 10.1016/j.jocn.2005.05.024. Epub 2007 Feb 1.
Decompressive hemicraniectomy as an appropriate treatment for malignant middle cerebral artery (MCA) infarction is still a controversial issue. This study aimed to determine the survival rate and functional outcome, and factors associated with these, in patients with malignant MCA infarction. From January 2000 to December 2003, 60 patients with malignant MCA infarction were treated in our hospital. All patients in the study underwent a large ipsilateral craniectomy and duroplasty for decompression. The infarction territory was evaluated by either diffusion weighted magnetic resonance imaging or computed tomography. Clinical neurological presentation was evaluated using the Glasgow Coma Scale. Functional outcome was evaluated using the Barthel index (BI) and the Glasgow Outcome Scale (GOS) at follow-up 12 months later. Thirty-day mortality was 20% (12 patients) and 12-month mortality was 26.6%. The factors associated with higher mortality were age>or=60 years, involvement of more than one vascular territory, presence of signs indicating clinical herniation before surgery, and treatment more than 24 hours after ictus. The mean GOS score was 3.3+/-1.7. The mean Barthel index was 65.1+/-40.1. Twenty-nine (65.9%) patients had a favourable outcome (BI>or=60). The factors associated with favourable outcome were age<60 years and treatment within 24 hours of ictus, before clinical signs of herniation were noted. Decompressive hemicraniectomy should be performed in patients younger than 60 years within 24 hours of ictus before clinical signs of herniation develop. Age, timing of surgery and clinical signs of herniation are prognostic factors for mortality and functional outcome.
减压性去骨瓣切除术作为恶性大脑中动脉(MCA)梗死的一种合适治疗方法仍是一个有争议的问题。本研究旨在确定恶性MCA梗死患者的生存率、功能结局以及与之相关的因素。2000年1月至2003年12月,我院对60例恶性MCA梗死患者进行了治疗。研究中的所有患者均接受了同侧大骨瓣切除术及硬脑膜成形术以进行减压。通过弥散加权磁共振成像或计算机断层扫描评估梗死区域。使用格拉斯哥昏迷量表评估临床神经学表现。在12个月后的随访中,使用巴氏指数(BI)和格拉斯哥结局量表(GOS)评估功能结局。30天死亡率为20%(12例患者),12个月死亡率为26.6%。与较高死亡率相关的因素包括年龄≥60岁、累及多个血管区域、术前存在提示临床脑疝的体征以及发病后24小时以上接受治疗。GOS评分的平均值为3.3±1.7。巴氏指数的平均值为65.1±40.1。29例(65.9%)患者预后良好(BI≥60)。与良好预后相关的因素包括年龄<60岁以及在出现临床脑疝体征之前于发病后24小时内接受治疗。对于年龄小于60岁、在出现临床脑疝体征之前于发病后24小时内的患者,应进行减压性去骨瓣切除术。年龄、手术时机和临床脑疝体征是死亡率和功能结局的预后因素。