Kumar Amandeep, Sharma Manish Singh, Sharma Bhawani Shanker, Bhatia Rohit, Singh Manmohan, Garg Ajay, Kumar Rajinder, Suri Ashish, Chandra Poodipedi Sarat, Kale Shashank Sharad, Mahapatra Ashok Kumar
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Indian Acad Neurol. 2013 Oct;16(4):509-15. doi: 10.4103/0972-2327.120445.
Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue.
This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS), Barthel index (BI) and improvement in language and motor function were evaluated to determine functional outcome.
Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18), 64% (11/17), 62.5% (10/16) and 62.5% (10/16) respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8) or without (5/8) support. Age <50 years corresponded with better functional outcome amongst survivors (P value -0.0068).
Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years) with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with.
大脑中动脉梗死（MCAI）后，10% - 15%的患者会发生危及生命的占位性梗死。尽管减压颅骨切除术（DC）目前是非优势半球卒中患者的标准治疗方法，但其在优势半球MCAI（DMCAI）中的作用在很大程度上尚不明确。这可能反映了拯救一名随后可能仍偏瘫和失语患者生命的伦理困境。本研究专门探讨了这个问题。
这项回顾性分析研究了接受DC的DMCAI患者。仔细查阅患者记录、手术记录、放射学资料和门诊档案以整理数据。评估格拉斯哥预后量表（GOS）、巴氏指数（BI）以及语言和运动功能的改善情况以确定功能结局。
纳入了18名年龄在22岁至72岁之间的患者。6周、3个月、6个月和总体生存率分别为66.6%（12/18）、64%（11/17）、62.5%（10/16）和62.5%（10/16）。在10名接受长期随访的存活患者中，60%的患者GOS有所改善，70%的患者BI评分>60，而30%的患者实现了完全功能独立。在该组中，分别有9名和8名患者的运动能力和语言功能得到改善。在最后一次随访时，10名存活患者中有8名能够行走，其中3名需要（3/8）或5名不需要（5/8）辅助。年龄<50岁与存活者中更好的功能结局相关（P值 -0.0068）。
DMCAI患者DC后的语言和运动结局并不像通常认为的那样糟糕。也许对于年轻的（<50岁）DMCAI患者，应该采用目前用于非DMCAI患者的同样积极的治疗方法。
