Rodrigues Thiago Pereira, Rodrigues Mariana Athaniel Silva, Bocca Leonardo Favi, Chaddad-Neto Feres Eduardo, Cavalheiro Sergio, Junior Edson Amaro, Silva Gisele Sampaio, Suriano Italo Capraro, Centeno Ricardo Silva
Department of Neurology and Neurosurgery, Federal University of Sao Paulo, São Paulo, Brazil.
Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil.
Surg Neurol Int. 2022 Dec 16;13:580. doi: 10.25259/SNI_895_2022. eCollection 2022.
Malignant middle cerebral artery (MCA) infarction is associated with high mortality, mainly due to intracranial hypertension. This malignant course develops when two-thirds or more of MCA territory is infarcted. Randomized clinical trials demonstrated that in patients with malignant MCA infarction, decompressive craniectomy (DC) is associated with better prognosis. In these patients, some prognostic predictors are already known, including age and time between stroke and DC. The size of bone flap was not associated with long-term prognosis in the previous studies. Therefore, this paper aims to further expand the analysis of the bone removal toward a more precise quantification and verify the prognosis implication of the bone flap area/whole supratentorial hemicranium relation in patients treated with DC for malignant middle cerebral infarcts.
This study included 45 patients operated between 2015 and 2020. All patients had been diagnosed with a malignant MCA infarction and were submitted to DC to treat the ischemic event. The primary endpoint was dichotomized modified Rankin scale (mRS) 1 year after surgery (mRS≤4 or mRS>4).
Patients with bad prognosis (mRS 5-6) were on average: older and with a smaller decompressive craniectomy index (DCI). In multivariate analysis, with adjustments for "age" and "time" from symptoms onset to DC, the association between DCI and prognosis remained.
In our series, the relation between bone flap size and theoretical maximum supratentorial hemicranium area (DCI) in patients with malignant MCA infarction was associated with prognosis. Further studies are necessary to confirm these findings.
大脑中动脉（MCA）恶性梗死与高死亡率相关，主要原因是颅内高压。当MCA供血区三分之二或更多发生梗死时，就会出现这种恶性病程。随机临床试验表明，对于恶性MCA梗死患者，减压颅骨切除术（DC）与更好的预后相关。在这些患者中，一些预后预测因素已经为人所知，包括年龄以及卒中与DC之间的时间。在以往研究中，骨瓣大小与长期预后无关。因此，本文旨在进一步扩大对去骨瓣的分析，实现更精确的量化，并验证在接受DC治疗的恶性大脑中动脉梗死患者中，骨瓣面积与整个幕上半颅骨面积的关系对预后的影响。
本研究纳入了2015年至2020年间接受手术的45例患者。所有患者均被诊断为恶性MCA梗死，并接受DC治疗缺血事件。主要终点是术后1年的二分制改良Rankin量表（mRS）（mRS≤4或mRS>4）。
预后不良（mRS 5 - 6）的患者平均年龄更大，减压颅骨切除指数（DCI）更小。在多变量分析中，对从症状发作到DC的“年龄”和“时间”进行调整后，DCI与预后之间的关联仍然存在。
在我们的系列研究中，恶性MCA梗死患者的骨瓣大小与理论上最大幕上半颅骨面积（DCI）之间的关系与预后相关。需要进一步研究来证实这些发现。
