Departments of Neurosurgery, University of Cincinnati and Mayfield Clinic, Cincinnati, OH, USA.
J Neurosurg. 2012 Oct;117(4):749-54. doi: 10.3171/2012.6.JNS111140. Epub 2012 Aug 24.
Although decompressive hemicraniectomy has been shown to reduce death and improve functional outcome following malignant middle cerebral artery territory infarction, there is ongoing debate as to whether surgery should be routinely performed, considering the very high rates of disability and functional dependence in survivors. Through a systematic review of the literature, the authors sought to determine the outcome from a patient's perspective.
In September 2010, a MEDLINE search of the English-language literature was performed using various combinations of 12 key words. A total of 16 papers were reviewed and individual study data were extracted.
There was significant variability in study design, patient eligibility criteria, timing of surgery, and methods of outcome assessment. There were 382 patients (59% male, 41% female) with a mean age of 50 years, 25% with dominant-hemisphere infarction. The mortality rate was 24% and the mean follow-up in survivors was 19 months (range 3-114 months). Of 156 survivors with available modified Rankin Scale (mRS) scores, 41% had favorable functional outcome (mRS Score ≤ 3), whereas 47% had moderately severe disability (mRS Score 4). Among 157 survivors with quality of life assessment, the mean overall reduction was 45%: 67% for physical aspect and 37% for psychosocial aspect. Of 114 screened survivors, depression affected 56% and was moderate or severe in 25%. Most patients and/or caregivers (77% of the 209 interviewed) were satisfied and would give consent again for the procedure.
Despite high rates of physical disability and depression, the vast majority of patients are satisfied with life and do not regret having undergone surgery.
虽然去骨瓣减压术已被证明可降低恶性大脑中动脉区域梗死患者的死亡率并改善其功能预后，但由于幸存者的残疾和功能依赖率非常高，因此对于是否应常规进行手术仍存在争议。作者通过对文献进行系统评价，旨在从患者角度确定结局。
作者于 2010 年 9 月使用 12 个关键词的各种组合对英文文献进行了 MEDLINE 搜索。共评价了 16 篇论文并提取了各研究的数据。
研究设计、患者入选标准、手术时机和结局评估方法存在显著差异。共有 382 例患者（59%为男性，41%为女性），平均年龄 50 岁，25%为优势半球梗死。死亡率为 24%，幸存者的平均随访时间为 19 个月（3-114 个月）。156 例可获得改良 Rankin 量表（mRS）评分的幸存者中，41%的功能结局良好（mRS 评分≤3），47%的幸存者为中重度残疾（mRS 评分 4）。157 例具有生活质量评估的幸存者中，平均总体下降 45%：身体方面 67%，心理社会方面 37%。在 114 例经筛选的幸存者中，56%存在抑郁，25%为中重度抑郁。大多数患者和/或照顾者（209 例接受采访者中的 77%）对生活感到满意，愿意再次接受手术。
尽管存在较高的躯体残疾和抑郁发生率，但绝大多数患者对生活感到满意，并不后悔接受手术。
