- 作者：Dean B. Kostov ; Richard H. Singleton ; David Panczykowski ; Hilal A. Kanaan ; Michael B. Horowitz ; Tudor Jovin ; Brian T. Jankowitz ; jankowitzbt@upmc.edu
- 关键词：Decompressive hemicraniectomy ; Malignant MCA syndrome ; Stroke ; Strokectomy
- 刊名：World Neurosurgery
- 出版年：2012
- 出版时间：November, 2012
- 年：2012
- 卷：78
- 期：5
- 页码：480-486
- 全文大小：772 K
Objective
We sought to evaluate the impact of a craniotomy for strokectomy (CS) with bone replacement, decompressive hemicraniectomy (DHC), or DHC with a strokectomy (DHC+S) on outcome after malignant supratentorial infarction.Methods
We conducted a retrospective cohort study of cases of malignant supratentorial infarction treated by CS (n = 18), DHC (n = 17), or DHC+S (n = 33) at our institution from 2002 to 2008. End points included functional outcome measured by the modified Rankin Scale and incidence of mortality at 1 year.
Results
Mean age, gender, side, vessel, and time from ictus to surgery were not statistically different between treatment groups. Stroke volume was significantly higher in the CS group. Operative time and blood loss were significantly higher in the DHC+S group. At 1 year, the median modified Rankin Scale score was 4 and overall survival was 71 % . Functional outcomes and mortality for both the CS and DHC+S groups were not significantly different from the DHC group (P = 0.24). After adjusting for patient age, stroke volume, and time to surgery, there was no significant difference in outcome.
Conclusion
In patients with malignant supratentorial infarction, a strokectomy alone may be equivalent to a decompressive hemicraniectomy with or without brain resection.