Bansal Hanish, Chaudhary Ashwani, Singh Apinderpreet, Paul Birinder, Garg Rajveer
Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Asian J Neurosurg. 2015 Jul-Sep;10(3):203-6. doi: 10.4103/1793-5482.161191.
Decompressive craniectomy as a surgical treatment for brain edema has been performed for many years and for several different pathophysiologies, including malignant middle cerebral artery (MCA) infarct. The purpose of this article was to share author's experience with decompressive craniectomy in malignant MCA infarct with special emphasis on patients older than 60 years and those operated outside 48 h after onset of stroke.
Totally, 53 patients who underwent decompressive craniectomy after malignant MCA infarction between January 2012 and May 2014 at tertiary care hospital were analyzed for preoperative clinical condition, timing of surgery, cause of infarction, and location and extension of infarction. The outcome was assessed in terms of mortality and scores like modified Rankin scale (mRS).
Totally, 53 patients aged between 22 and 80 years (mean age was 54.92 ± 11.8 years) were analyzed in this study. Approximately, 60% patients were older than 60 years. Approximately, 74% patients operated within 48 h (25 patients) had mRS 0-3 at discharge while 56% patients operated after 48 h had mRS 0-3 at discharge which is not significant statistically. 78% patients aged below 60 years had mRS 0-3 at discharge while only 38% patients aged above 60 years had mRS 0-3 at discharge which was statistically significant (P < 0.008).
Decompressive craniectomy has reduced morbidity and mortality especially in people aged below 60 years and those operated within 48 h of malignant MCA stroke though those operated outside 48 h of stroke also fare well neurologically, there is no reason these patients should be denied surgery.
去骨瓣减压术作为治疗脑水肿的一种外科手术已开展多年，用于多种不同的病理生理情况，包括恶性大脑中动脉（MCA）梗死。本文旨在分享作者在恶性MCA梗死患者中进行去骨瓣减压术的经验，特别关注60岁以上患者以及在卒中发病后48小时以外进行手术的患者。
对2012年1月至2014年5月在三级医院接受恶性MCA梗死后去骨瓣减压术的53例患者，分析其术前临床状况、手术时机、梗死原因以及梗死的部位和范围。根据死亡率和改良Rankin量表（mRS）等评分评估结果。
本研究共分析了53例年龄在22至80岁之间（平均年龄为54.92±11.8岁）的患者。约60%的患者年龄超过60岁。约74%在48小时内接受手术的患者（25例）出院时mRS为0 - 3，而48小时后接受手术的患者中56%出院时mRS为0 - 3，差异无统计学意义。60岁以下患者78%出院时mRS为0 - 3，而60岁以上患者仅38%出院时mRS为0 - 3，差异有统计学意义（P < 0.008）。
去骨瓣减压术降低了发病率和死亡率，尤其是在60岁以下患者以及在恶性MCA卒中48小时内接受手术的患者中。尽管在卒中48小时后接受手术的患者神经功能恢复也较好，但没有理由拒绝这些患者接受手术。
