Mian Asim Z, Edasery David, Sakai Osamu, Mustafa Qureshi M, Holsapple James, Nguyen Thanh
Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3, Boston, MA 02118, USA.
Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Neuroradiology. 2017 May;59(5):477-484. doi: 10.1007/s00234-017-1823-1. Epub 2017 Mar 28.
Predicting which patients are at risk for hemicraniectomy can be helpful for triage and can help preserve neurologic function if detected early. We evaluated basal ganglia imaging predictors for early hemicraniectomy in patients with large territory anterior circulation infarct.
This retrospective study evaluated patients with ischemic infarct admitted from January 2005 to July 2011. Patients with malignant cerebral edema refractory to medical therapy or with herniating signs such as depressed level of consciousness, anisocoria, and contralateral leg weakness were triaged to hemicraniectomy. Admission images were reviewed for presence of caudate, lentiform nucleus (putamen and globus pallidus), or basal ganglia (caudate + lentiform nucleus) infarction.
Thirty-one patients with large territory MCA infarct, 10 (32%), underwent hemicraniectomy. Infarction of the caudate nucleus (9/10 vs 6/21, p = 0.002) or basal ganglia (5/10 vs 2/21, p = 0.02) predicted progression to hemicraniectomy. Infarction of the lentiform nucleus only did not predict progression to hemicraniectomy. Sensitivity for patients who did and did not have hemicraniectomy were 50% (5/10) and 90.5% (19/21). For caudate nucleus and caudate plus lentiform nucleus infarcts, the crude- and age-adjusted odds of progression to hemicraniectomy were 9.5 (1.4-64.3) and 6.6 (0.78-55.4), respectively.
Infarction of the caudate nucleus or basal ganglia correlated with patients progressing to hemicraniectomy. Infarction of the lentiform nucleus alone did not.
预测哪些患者有进行去骨瓣减压术的风险，有助于进行分诊，并且如果能早期发现，有助于保护神经功能。我们评估了大面积前循环梗死患者早期去骨瓣减压术的基底节影像学预测指标。
这项回顾性研究评估了2005年1月至2011年7月收治的缺血性梗死患者。对内科治疗难治的恶性脑水肿患者或出现意识水平下降、瞳孔不等大、对侧腿部无力等脑疝体征的患者进行去骨瓣减压术分诊。回顾入院时的影像，检查是否存在尾状核、豆状核（壳核和苍白球）或基底节（尾状核+豆状核）梗死。
31例大面积大脑中动脉梗死患者中，10例（32%）接受了去骨瓣减压术。尾状核梗死（9/10对6/21，p = 0.002）或基底节梗死（5/10对2/21，p = 0.02）可预测进展为去骨瓣减压术。仅豆状核梗死不能预测进展为去骨瓣减压术。接受和未接受去骨瓣减压术患者的敏感性分别为50%（5/10）和90.5%（19/21）。对于尾状核梗死以及尾状核加豆状核梗死，进展为去骨瓣减压术的粗比值比和年龄调整比值比分别为9.5（1.4 - 64.3）和6.6（0.78 - 55.4）。
尾状核或基底节梗死与进展为去骨瓣减压术的患者相关。单独的豆状核梗死则不然。
