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KMID : 1005420090110020049
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Journal of Cerebrovascular and Endovascular Neurosurgery
2009 Volume.11 No. 2 p.49 ~ p.54
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Decompressive Craniectomy for Malignant Middle Cerebral Infarction
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Hwang Gyo-Jun
Oh Chang-Wan
Han Jeong-Ho
Kim Chae-Yong
Kwon O-Ki
Park Sukh-Que
Han Moon-Ku
Bae Hee-Joon
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Abstract
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Decompressive craniectomy is used to treat increased intracranial pressure due to brain swelling in middle cerebral artery infarction. Recently, 3 European multicenter, prospective, randomized trials and a pooled analysis were published. In the pooled analysis, decompressive craniectomy did not appear to increase the risk of complete dependency, misery, and hopelessness. Exactly 2 patients in the surgical and medical groups (5%) were bedbound and severely disabled (mRS 5) at 1 year. The proportion of patients alive with minimal-tomoderate disability (mRS 0-3), however, was significantly increased from 21% to 43%. Decompressive craniectomy resulted in a 49% absolute risk reduction in death, and an absolute increase in the proportion of patients rated as mRS 2 of 12%, mRS 3 of 10%, and mRS 4 of 29%. But, this can be applied in cases with relative young age and early surgical procedure. Therefore, the indication for decompressive
craniectomy should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.
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KEYWORD
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Decompressive craniectomy, Malignant middle cerebral artery infarction, Intracranial hypertension
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