Paliwal Prakash, Kazmi Farasat, Teoh Hock Luen, Yeo Leonard L L, Seet Raymond C S, Yeo Tseng Tsai, Sein Lwin, Chou Ning, Tan Thomas, Chan Bernard P L, Sharma Vijay K
Division of Neurology, Department of Medicine, National University Hospital, Singapore.
Department of Surgery, National University Hospital, Singapore.
World Neurosurg. 2018 Mar;111:e722-e728. doi: 10.1016/j.wneu.2017.12.157. Epub 2018 Jan 6.
Early decompression craniectomy (within 48 hours of stroke onset) in acute and malignant middle cerebral artery (MCA) ischemic stroke (IS) reduces mortality and increases the proportion of patients with favorable functional outcome. Various cultural and social issues among Asians lead to some differences in clinical practice, especially when surgical interventions are involved. Accordingly, decompressive craniectomy in Asian patients with stroke is often delayed.
Data for all patients with acute IS hospitalized in our center were entered into a prospectively maintained registry. In this retrospective analysis, data for all patients with malignant MCA IS who underwent decompressive craniectomy were extracted. Various demographic, clinical, and neuroimaging factors were analyzed for identifying independent predictors of favorable functional outcome at 6 months, which was defined as modified Rankin Scale score of 0-3 points.
From January 2005 to December 2014, a total of 75 patients with acute MCA IS underwent decompressive craniectomy. Median age was 55 years (interquartile range 44-64) with male preponderance (66%) and median National Institute of Health Stroke Scale score 21 points (interquartile range 18-24). A considerable proportion of these patients (38.7%) received intravenous thrombolysis. The majority (70%) of patients suffered right MCA IS, and decompressive surgery was performed within 48 hours of symptom onset in 50 (67%) of the patients. Favorable functional outcome was achieved in 25 (33.3%) patients at 6 months. Right MCA stroke (odds ratio 9.158; 95% confidence interval 1.881-44.596, P = 0.006) and early decompression surgery (odds ratio 4.011; 95% confidence interval 1.058-15.208, P = 0.041) were independent predictors of favorable functional outcome at 6 months.
Early decompression craniectomy, especially in right MCA ischemic stroke, is associated with better favorable functional outcome.
急性恶性大脑中动脉（MCA）缺血性卒中（IS）患者在发病48小时内进行早期减压颅骨切除术可降低死亡率，并提高功能预后良好患者的比例。亚洲人存在各种文化和社会问题，这导致临床实践存在一些差异，尤其是涉及手术干预时。因此，亚洲卒中患者的减压颅骨切除术往往会延迟。
将在本中心住院的所有急性IS患者的数据录入前瞻性维护的登记册。在这项回顾性分析中，提取了所有接受减压颅骨切除术的恶性MCA IS患者的数据。分析了各种人口统计学、临床和神经影像学因素，以确定6个月时功能预后良好的独立预测因素，6个月时功能预后良好定义为改良Rankin量表评分为0 - 3分。
2005年1月至2014年12月，共有75例急性MCA IS患者接受了减压颅骨切除术。中位年龄为55岁（四分位间距44 - 64岁），男性占优势（66%），美国国立卫生研究院卒中量表中位评分为21分（四分位间距18 - 24分）。这些患者中有相当一部分（38.7%）接受了静脉溶栓治疗。大多数患者（70%）发生右侧MCA IS，50例（67%）患者在症状发作后48小时内进行了减压手术。25例（33.3%）患者在6个月时功能预后良好。右侧MCA卒中（比值比9.158；95%置信区间1.
