Uhl E
Department of Neurosurgery, LKH Klagenfurt, Klagenfurt, Austria.
Cent Eur Neurosurg. 2009 Nov;70(4):195-206. doi: 10.1055/s-0029-1216362. Epub 2009 Oct 21.
The development of a space-occupying hemispheric infarction occurs in a subset of patients with ischaemic cerebrovascular stroke. It is a life-threatening condition with a high mortality rate of up to 80% with medical therapy alone. Previous retrospective and uncontrolled case series have suggested that decompressive hemicraniectomy can significantly reduce mortality to 20-30% compared to conservative treatment. This evidence has now been confirmed by the data of prospective randomised studies. The data also indicate that the reduction of mortality is not accompanied by an increase in the number of completely disabled patients. However, the number of disabled patients depending on the assistance of others increases significantly, and the patients and their caregivers need to be comprehensively informed about the long-term consequences prior to surgery. Furthermore, questions concerning the optimal time point for decompression and the upper age limit at which patients still benefit from surgery remain unanswered. Thus the indication for surgery is to a great extent still dependent on the individual situation of the patient and the experience of the treating physicians. This review covers the indications, the surgical technique, the prognostic factors and the clinical outcome with this procedure based on the data of retrospective series and the results of the recently published prospective randomised trials.
占位性半球梗死在缺血性脑血管卒中患者的一个亚组中发生。它是一种危及生命的疾病，仅采用药物治疗时死亡率高达80%。既往回顾性和非对照病例系列研究提示，与保守治疗相比，减压性颅骨切除术可将死亡率显著降低至20% - 30%。这一证据现已被前瞻性随机研究的数据所证实。数据还表明，死亡率降低并未伴随完全残疾患者数量的增加。然而，依赖他人协助的残疾患者数量显著增加，术前需要向患者及其护理人员全面告知长期后果。此外，关于减压的最佳时间点以及患者仍能从手术中获益的年龄上限等问题仍未得到解答。因此，手术指征在很大程度上仍取决于患者的个体情况以及治疗医师的经验。本综述基于回顾性系列研究的数据以及最近发表的前瞻性随机试验结果，涵盖了该手术的指征、手术技术、预后因素及临床结局。
