Gupta Aman, Sattur Mithun G, Aoun Rami James N, Krishna Chandan, Bolton Patrick B, Chong Brian W, Demaerschalk Bart M, Lyons Mark K, McClendon Jamal, Patel Naresh, Sen Ayan, Swanson Kristin, Zimmerman Richard S, Bendok Bernard R
Department of Neurological Surgery, Mayo Clinic Hospital, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; Precision Neuro-theraputics Innovation Lab, Mayo Clinic Hospital, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic Hospital, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Department of Neurological Surgery, Mayo Clinic Hospital, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Neurosurg Clin N Am. 2017 Jul;28(3):349-360. doi: 10.1016/j.nec.2017.02.010.
Malignant large artery stroke is associated with high mortality of 70% to 80% with best medical management. Decompressive craniectomy (DC) is a highly effective tool in reducing mortality. Convincing evidence has accumulated from several randomized trials, in addition to multiple retrospective studies, that demonstrate not only survival benefit but also improved functional outcome with DC in appropriately selected patients. This article explores in detail the evidence for DC, nuances regarding patient selection, and applicability of DC for supratentorial intracerebral hemorrhage and posterior fossa ischemic and hemorrhagic stroke.
恶性大动脉卒中在最佳药物治疗下死亡率高达70%至80%。去骨瓣减压术（DC）是降低死亡率的一种高效手段。除多项回顾性研究外，多项随机试验已积累了令人信服的证据，表明在适当选择的患者中，DC不仅能带来生存获益，还能改善功能结局。本文详细探讨了DC的证据、患者选择的细微差别以及DC在幕上脑出血和后颅窝缺血性及出血性卒中中的适用性。
