Takeuchi Satoru, Wada Kojiro, Nawashiro Hiroshi, Arimoto Hirohiko, Ohkawa Hidenori, Masaoka Hiroyuki, Otani Naoki, Takasato Yoshio
Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
Clin Neurol Neurosurg. 2012 Dec;114(10):1312-5. doi: 10.1016/j.clineuro.2012.03.044. Epub 2012 Apr 11.
Intravenous tissue plasminogen activator (IV tPA) is an approved treatment for acute ischemic stroke. However, the effects of decompressive craniectomy (DC) after IV tPA administration for ischemic stroke are still largely unknown. The aim of this study was to investigate the safety and outcomes of DC after IV tPA administration.
We retrospectively reviewed patients who underwent DC for malignant hemispheric infarction. We compared 20 patients who underwent DC after IV tPA administration with another 20 patients who underwent DC without prior IV tPA administration.
The patient characteristics did not differ between the DC patients with and without prior IV tPA administration. New intracranial bleeding or worsening of pre-existing ICH occurred in two patients (10%) in each group. Furthermore, the rates of an mRS score of 4-6, 5 or 6, and 6 did not differ significantly between the two groups.
DC may be a safe and useful surgical procedure for space-occupying edema after IV tPA administration for acute stroke.
静脉注射组织型纤溶酶原激活剂（IV tPA）是急性缺血性卒中的一种已获批准的治疗方法。然而，在静脉注射tPA治疗缺血性卒中后进行去骨瓣减压术（DC）的效果仍大多未知。本研究的目的是探讨静脉注射tPA后进行去骨瓣减压术的安全性和疗效。
我们回顾性分析了因恶性半球梗死接受去骨瓣减压术的患者。我们将20例静脉注射tPA后接受去骨瓣减压术的患者与另外20例未预先静脉注射tPA而接受去骨瓣减压术的患者进行了比较。
预先接受静脉注射tPA和未接受静脉注射tPA的去骨瓣减压术患者的特征无差异。每组各有两名患者（10%）出现新的颅内出血或原有脑出血恶化。此外，两组之间改良Rankin量表（mRS）评分为4 - 6分、5或6分以及6分的比例无显著差异。
对于急性卒中静脉注射tPA后出现的占位性水肿，去骨瓣减压术可能是一种安全且有用的外科手术。
