Al-Jehani Hosam, Petrecca Kevin, Martel Phillipe, Sinclair David, Sirhan Denis
Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, King Fahad Hospital of the University, University of Dammam, Al-Khobar, Saudi Arabia.
Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada.
J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2177-83. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.039. Epub 2016 Jul 25.
Decompressive hemicraniectomy (DhC) is a life-saving surgical procedure being increasingly employed for malignant middle cerebral artery strokes. We examined the incidence of hemorrhagic transformation following DhC.
We retrospectively reviewed the charts and radiological images of patients who underwent DhC for malignant middle cerebral artery strokes. We classified the hemorrhagic events and assessed the short-term 30-day outcome associated with these events.
A total of 23 DhCs were performed for supratentorial ischemic strokes in 22 patients. There were 16 males and 6 females with an average age of 47 years (21-69 years). Of the 22 patients, 13 (59%) developed a new hemorrhage following DhC. There were 3 mortalities (14%). Of the survivors, 6 (27%) were discharged home with a modified Rankin Scale (mRS) score of 2. The remaining 13 patients (59%) recovered to a degree wherein they were discharged to a rehabilitation center (mRS score 3-4). No patient persisted in a vegetative or semivegetative state (mRS score 5).
In this study, the rate of hemorrhagic transformation following DhC for ischemic stroke was 59%. This is much higher than that reported in the stroke thrombolysis literature. The presence of any type of new hemorrhagic transformation in this patient population does not appear to alter the natural history of their ischemic strokes in terms of Glasgow outcome scores or destination of disposition.
减压性颅骨切除术（DhC）是一种用于治疗恶性大脑中动脉卒中的挽救生命的外科手术。我们研究了DhC术后出血性转化的发生率。
我们回顾性分析了因恶性大脑中动脉卒中接受DhC治疗的患者的病历和影像学资料。我们对出血事件进行分类，并评估与这些事件相关的短期30天预后。
22例患者共进行了23次针对幕上缺血性卒中的DhC手术。其中男性16例，女性6例，平均年龄47岁（21 - 69岁）。22例患者中，13例（59%）在DhC术后出现了新的出血。有3例死亡（14%）。在幸存者中，6例（27%）出院时改良Rankin量表（mRS）评分为2分。其余13例患者（59%）恢复到一定程度后被转至康复中心（mRS评分3 - 4分）。没有患者持续处于植物人或半植物人状态（mRS评分5分）。
在本研究中，缺血性卒中患者接受DhC术后出血性转化的发生率为59%。这远高于卒中溶栓文献中报道的发生率。在该患者群体中，任何类型的新出血性转化的出现似乎都不会改变其缺血性卒中在格拉斯哥预后评分或出院去向方面的自然病程。
