Pallesen Lars-Peder, Barlinn Kristian, Puetz Volker
Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Front Neurol. 2019 Jan 9;9:1119. doi: 10.3389/fneur.2018.01119. eCollection 2018.
Ischemic stroke is one of the leading causes for death and disability worldwide. In patients with large space-occupying infarction, the subsequent edema complicated by transtentorial herniation poses a lethal threat. Especially in patients with malignant middle cerebral artery infarction, brain swelling secondary to the vessel occlusion is associated with high mortality. By decompressive craniectomy, a significant proportion of the skull is surgically removed, allowing the ischemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. Several studies have shown that decompressive craniectomy reduces the mortality rate in patients with malignant cerebral artery infarction. However, this is done for the cost of a higher proportion of patients who survive with severe disability. In this review, we will describe the clinical and radiological features of malignant middle cerebral artery infarction and the role of decompressive craniectomy and additional therapies in this condition. We will also discuss large cerebellar stroke and the possibilities of suboccipital craniectomy.
缺血性中风是全球范围内导致死亡和残疾的主要原因之一。在患有大面积占位性梗死的患者中，随后并发经天幕疝的水肿构成致命威胁。特别是在恶性大脑中动脉梗死患者中，血管闭塞继发的脑肿胀与高死亡率相关。通过减压颅骨切除术，相当一部分颅骨被手术切除，使缺血组织能够通过手术缺损移位，而不是向大脑未受影响的区域移位，从而避免因颅内压升高导致的继发性损伤。多项研究表明，减压颅骨切除术可降低恶性大脑中动脉梗死患者的死亡率。然而，这样做是以更高比例的患者存活但伴有严重残疾为代价的。在本综述中，我们将描述恶性大脑中动脉梗死的临床和放射学特征，以及减压颅骨切除术和其他治疗方法在这种情况下的作用。我们还将讨论小脑大面积中风以及枕下颅骨切除术的可能性。
