Algethamy Haifa M, Samman Afnan, Baeesa Saleh S, Almekhlafi Mohammed A, Al Said Yousef A, Hassan Ahmed
Department of Critical Care Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Neurosciences (Riyadh). 2017 Jul;22(3):192-197. doi: 10.17712/nsj.2017.3.20170051.
To describe our experience implementing decompressive hemicraniectomy (DH) for eligible patients with malignant middle cerebral artery (MCA) infarcts.
We retrospectively collected data of malignant MCA infarction patients requiring DH at King Abdulaziz University Hospital & King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia between October 2010 and July 2015. Clinical outcome was assessed immediately postoperatively using Glasgow Coma Score (GCS), and at 12 months using the modified Rankin scale (mRS) and Barthel index. Survival was evaluated at thirty-days and one year after surgery.
Six out of 10 patients diagnosed with malignant MCA infarction underwent DH. Among the surgically treated patients (n=6), 4 were males (66%), and the median age was 22.5 years. The median time from admission to surgery was 35.5 hours. The median post-operative GCS was 6.5. Three patients (50%) died within 30 days of DH. In those who survived, the median mRS was 4.5 and BI was 7.5.
Decompressive hemicraniectomy saves life and has the potential of improving survival functional outcome when done fast and in carefully selected patients. We call for national awareness of the management of such cases and early intervention.
描述我们对符合条件的恶性大脑中动脉（MCA）梗死患者实施减压性颅骨切除术（DH）的经验。
我们回顾性收集了2010年10月至2015年7月期间在沙特阿拉伯王国吉达市阿卜杜勒阿齐兹国王大学医院、法赫德国王专科医院及研究中心需要进行DH的恶性MCA梗死患者的数据。术后立即使用格拉斯哥昏迷评分（GCS）评估临床结局，并在12个月时使用改良Rankin量表（mRS）和Barthel指数进行评估。在术后30天和1年评估生存率。
10例被诊断为恶性MCA梗死的患者中有6例接受了DH。在接受手术治疗的患者（n = 6）中，4例为男性（66%），中位年龄为22.5岁。从入院到手术的中位时间为35.5小时。术后中位GCS为6.5。3例患者（50%）在DH后30天内死亡。在存活的患者中，中位mRS为4.5，BI为7.5。
减压性颅骨切除术可挽救生命，并且在快速实施且患者选择谨慎时有可能改善生存功能结局。我们呼吁全国对此类病例的管理提高认识并进行早期干预。
