Xie Shao, Ding Jiahai, Yao Yuancheng, Huang Xiaoya, Chen Yuliang, Xiong Yang, Zhang Tong, Liu Yong, Wang Lei
Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
J Korean Neurosurg Soc. 2025 Jul;68(4):405-414. doi: 10.3340/jkns.2024.0210. Epub 2025 May 23.
Massive cerebral infarction caused by middle cerebral artery infarction leads to extensive cerebral infarction in one hemisphere, resulting in swelling of the brain and further compression of surrounding normal brain tissue, ultimately leading to a complete cerebral infarction and a mortality rate of about 50-80% for patients. Although early decompressive craniectomy and partial internal decompression can reduce mortality rates, neurosurgeons should strive to achieve lower mortality rates in the face of patients' lives. This study introduces a surgical method with lower mortality rate, which is a rapid internal decompression technique for cerebral hemisphere resection through a flat bone window after decompressive craniectomy (DC) and partial temporal lobe resection.
From March 2022 to March 2024, 18 patients with extensive cerebral infarction underwent craniotomy and partial temporal lobectomy, craniectomy combined with rapid internal decompression (CCRID). Standard large bone flap craniotomy and anterior temporal lobe resection were performed. Circular electrocoagulation of the arachnoid membrane 1 cm inside the bone window, with sharp cutting, and then rapid resection of necrotic brain tissue outside the bone window (the height of the removed necrotic brain tissue is about 1-2 cm), while electrocoagulating the blood vessels from front to back along the direction of blood vessel formation. Place the drainage tube and intracranial pressure monitoring catheter for 1-2 days. Clinical outcomes were compared to 24 patients who underwent DC combined with partial temporal/frontal pole resection (DCPTR).
The average age of 18 patients was 63 years. The mean cerebral hemisphere resection time was 6.8 minutes with total surgery averaging 2.82 hours. Postoperative ICP averaged 4 mmHg, and the midline shifted back by 0.45 cm. At 3 months, there was one intracerebral hemorrhage, no infections, and a mortality rate of 11.1%. The mean modified Rankin scale score was 4.45. Compared to DCPTR, CCRID showed similar midline shift, shorter surgery time, and lower mortality.
CCRID may represent a viable decompression technique for patients with massive hemispheric infarctions, warranting further consideration for future applications.
大脑中动脉梗死导致的大面积脑梗死会致使一侧半球广泛脑梗死，引起脑肿胀并进一步压迫周围正常脑组织，最终导致完全性脑梗死，患者死亡率约为50 - 80%。尽管早期减压性颅骨切除术和部分内减压术可降低死亡率，但面对患者生命，神经外科医生应努力实现更低的死亡率。本研究介绍一种死亡率较低的手术方法，即减压性颅骨切除术（DC）和部分颞叶切除术后通过扁平骨窗进行大脑半球切除的快速内减压技术。
2022年3月至2024年3月，18例大面积脑梗死患者接受了开颅手术和部分颞叶切除术，即颅骨切除术联合快速内减压术（CCRID）。实施标准大骨瓣开颅术和前颞叶切除术。在骨窗内1 cm处对蛛网膜进行环形电凝，锐性切割，然后快速切除骨窗外坏死脑组织（切除的坏死脑组织高度约为1 - 2 cm），同时沿血管形成方向从前向后电凝血管。放置引流管和颅内压监测导管1 - 2天。将临床结果与24例接受DC联合部分颞叶/额极切除术（DCPTR）的患者进行比较。
18例患者的平均年龄为63岁。大脑半球平均切除时间为6.8分钟，总手术时间平均为2.82小时。术后平均颅内压为4 mmHg，中线移位回0.45 cm。3个月时，发生1例脑出血，无感染，死亡率为11.1%。改良Rankin量表平均评分为4.45。与DCPTR相比，CCRID的中线移位相似，手术时间更短，死亡率更低。
CCRID可能是大面积半球梗死患者一种可行的减压技术，值得未来进一步考虑应用。
