|
KMID : 1005420190210030138
|
|
Journal of Cerebrovascular and Endovascular Neurosurgery
2019 Volume.21 No. 3 p.138 ~ p.143
|
|
|
Maximum Decompressive Hemicraniectomy for Patients with Malignant Hemispheric Infarction
|
|
Kwak Young-Seok
Kim Byoung-Joon
Park Jae-Chan
|
|
|
Abstract
|
|
|
Objective : The authors applied maximum external decompression for malignant hemispheric infarct ion and investigated the functional outcome according to the patient age.
Methods : Twenty-five patients with malignant hemispheric infarction were treated using a hemicraniectomy with maximum external decompression, comprising a larger (>14cm) hemicraniectomy, resection of the temporalis muscle and its fascia, spaciously expansive duraplasty, and approximation of the skin flap. The medical and diagnostic imaging records for the patients were reviewed, and 1-year functional outcome data obtained for the younger group (aged ≤ 60 years) and elderly group (aged > 60 years).
Results : The patients (n=25) who underwent maximum surgical decompression revealed a minimal mortality rate (n=2, 8.0%). The patients (n=14) in the younger group all survived with mRS scores of 2 (n=1, 7.1%), 3 (n=7, 50.0%), 4 (n=3, 21.4%), or 5 (n=3, 21.4%). A majority of the younger patients (57.1% with mRS ≤3) lived with functional independence. When the 1-year mRS scores were dichotomized between favorable (mRS ≤3) and unfavorable (mRS ≥4) outcomes, the younger group had significantly more patients with a favorable outcome than the elderly group (57.1% versus 9.1%, p=0.033). In contrast, in the elderly group, most patients showed unfavorable outcomes with the mRS scores of 4 (n=5, 45.5%), 5 (n=3, 27.3%), or 6 (n=2, 18.2%), whereas only one patient showed favorable outcome (mRS 3). A majority of the elderly patients (45.5% with mRS 4) survived with moderately severe disability.
Conclusion : For malignant hemispheric infarction, a hemicraniectomy with maximum external decompression was found to considerably increase survival with a favorable outcome in functional independence (mRS ≤3) for younger patients aged ≤60 years. It can be optimal surgical treatment for younger patients.
|
|
|
KEYWORD
|
|
|
Cerebral infarction, Decompressive hemicraniectomy, Surgical decompression, Temporalis muscle, Treatment outcome
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
 
|
|