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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction.
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Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction.

机译：恶性脑中动脉梗死减压半颅切除术的结果和预后因素。

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摘要

Decompressive hemicraniectomy as an appropriate treatment for malignant middle cerebral artery (MCA) infarction is still a controversial issue. This study aimed to determine the survival rate and functional outcome, and factors associated with these, in patients with malignant MCA infarction. From January 2000 to December 2003, 60 patients with malignant MCA infarction were treated in our hospital. All patients in the study underwent a large ipsilateral craniectomy and duroplasty for decompression. The infarction territory was evaluated by either diffusion weighted magnetic resonance imaging or computed tomography. Clinical neurological presentation was evaluated using the Glasgow Coma Scale. Functional outcome was evaluated using the Barthel index (BI) and the Glasgow Outcome Scale (GOS) at follow-up 12 months later. Thirty-day mortality was 20% (12 patients) and 12-month mortality was 26.6%. The factors associated with higher mortality were age>==60 years, involvement of more than one vascular territory, presence of signs indicating clinical herniation before surgery, and treatment more than 24 hours after ictus. The mean GOS score was 3.3+/-1.7. The mean Barthel index was 65.1+/-40.1. Twenty-nine (65.9%) patients had a favourable outcome (BI>==60). The factors associated with favourable outcome were age<60 years and treatment within 24 hours of ictus, before clinical signs of herniation were noted. Decompressive hemicraniectomy should be performed in patients younger than 60 years within 24 hours of ictus before clinical signs of herniation develop. Age, timing of surgery and clinical signs of herniation are prognostic factors for mortality and functional outcome.
机译：减压性半颅脑切除术作为治疗恶性脑中动脉（MCA）梗死的合适方法仍是一个有争议的问题。本研究旨在确定MCA恶性梗死患者的生存率和功能结局以及与之相关的因素。 2000年1月至2003年12月，我院收治60例MCA恶性梗死患者。该研究中的所有患者均进行了大型同侧颅骨切除术和硬膜成形术以减压。通过弥散加权磁共振成像或计算机断层扫描评估梗塞区域。临床神经系统表现使用格拉斯哥昏迷量表进行评估。在12个月后的随访中，使用Barthel指数（BI）和格拉斯哥成果量表（GOS）评估功能结局。三十天死亡率为20％（12例患者），十二个月死亡率为26.6％。与更高死亡率相关的因素有：年龄≥60岁，累及一个以上血管区域，在手术前出现迹象表明临床上有疝气，以及在发作后24小时以上进行治疗。平均GOS得分为3.3 +/- 1.7。 Barthel平均指数为65.1 +/- 40.1。 29名（65.9％）患者的预后良好（BI> == 60）。与良好预后相关的因素是年龄<60岁，在出现突出的临床体征之前在发作24小时内进行治疗。对于60岁以下的患者，在发作性临床症状出现之前，应在发作24小时之内进行减压半结肠切除术。年龄，手术时机和疝的临床体征是死亡率和功能预后的预后因素。

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