Merenda Amedeo, DeGeorgia Michael
Neurological Institute, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5040, USA.
Curr Opin Neurol. 2010 Feb;23(1):53-8. doi: 10.1097/WCO.0b013e328334bdf4.
Malignant hemispheric infarction is associated with a high mortality rate, approximately 80%, as a result of the development of intracranial pressure gradients, brain tissue shift, and herniation. By allowing the brain to swell outwards and equalizing pressure gradients, decompressive craniectomy appears to significantly reduce the mortality to approximately 20%. This review takes a comprehensive look at the evidence highlighting the benefits and limits of decompressive craniectomy in malignant cerebral infarction.
Three recent European randomized trials have provided compelling evidence that decompressive hemicraniectomy for large hemispheric infarction is not only lifesaving, but also leads to improved functional outcome in patients 60 years of age or less when treated within 48 h of stroke onset.
Early decompressive hemicraniectomy (<or=48 h) should be strongly considered in any patient 60 years old or less presenting with malignant hemispheric infarction. Further studies are needed to establish objective neuroimaging criteria for aggressive intervention, and to clarify the role of decompressive surgery in older patients (>60 years old) and perhaps, when delayed beyond 48 h.
恶性半球梗死因颅内压力梯度形成、脑组织移位和脑疝形成，死亡率较高，约为80%。通过使大脑向外膨出并平衡压力梯度，减压性颅骨切除术似乎可将死亡率显著降低至约20%。本综述全面审视了突出减压性颅骨切除术在恶性脑梗死中的益处和局限性的证据。
最近三项欧洲随机试验提供了令人信服的证据，表明对于大面积半球梗死行减压性去骨瓣减压术不仅能挽救生命，而且对于在卒中发作48小时内接受治疗的60岁及以下患者，还能改善功能结局。
对于任何患有恶性半球梗死的60岁及以下患者，应强烈考虑早期（≤48小时）减压性去骨瓣减压术。需要进一步研究以建立积极干预的客观神经影像学标准，并阐明减压手术在老年患者（>60岁）中以及或许在超过48小时延迟治疗时的作用。
