Ogasawara K, Koshu K, Nagamine Y, Fujiwara S, Mizoi K, Yoshimoto T
Department of Neurosurgery, Kohnan Hospital.
No Shinkei Geka. 1995 Jan;23(1):43-8.
The authors report 10 patients with progressive neurological deterioration due to massive cerebellar infarctions. Computerized tomography scans confirmed obstructive hydrocephalus and brain stem compression. All 10 patients (seven men, three women; mean age, 59 years) were treated by external ventricular drainage and decompressive suboccipital craniectomy. After discharge from the hospital, they were followed up (23-101 months) and their functional independence was evaluated by the Barthel Index. The condition of three patients with brain-stem infarction had deteriorated despite decompressive surgery. Two of these died during the acute stage and one because severely disabled. The remaining seven patients showed neurological improvement during the postoperative period. Four patients with preoperative Japan Coma Scale of 100 returned to their previous jobs within the follow-up period and three patients with preoperative Japan Coma Scale of 200 required some assistance in daily activities. It is suggested that decompressive surgery may be beneficial for massive cerebellar infarction. The postoperative prognosis depends mainly on the presence or absence of coexisting brain-stem infarction. It is possible that, without brain-stem infarction, patients who remained in a "dependent" state may have recovered better if they had been operated on earlier.
作者报告了10例因大面积小脑梗死导致进行性神经功能恶化的患者。计算机断层扫描证实存在梗阻性脑积水和脑干受压。所有10例患者（7例男性，3例女性；平均年龄59岁）均接受了脑室外引流和枕下减压颅骨切除术治疗。出院后，对他们进行了随访（23 - 101个月），并通过巴氏指数评估其功能独立性。尽管进行了减压手术，但3例脑干梗死患者的病情仍恶化。其中2例在急性期死亡，1例严重残疾。其余7例患者术后神经功能有所改善。4例术前日本昏迷量表评分为100分的患者在随访期间恢复了原工作，3例术前日本昏迷量表评分为200分的患者在日常生活中需要一些帮助。提示减压手术可能对大面积小脑梗死有益。术后预后主要取决于是否并存脑干梗死。如果没有脑干梗死，那些仍处于“依赖”状态的患者若能更早接受手术，可能恢复得更好。
