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KMID : 1150320160120020206
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Journal of Korean Society of Geriatric Neurosurgery
2016 Volume.12 No. 2 p.206 ~ p.211
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The Effect of Decompressive Craniectomy in Elderly Patients Aged 80 and Over with Middle Cerebral Artery Infarction
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Han Ho-Kyun
Koh Eun-Jung
Choi Hyun-Ho
Kim Byong-Cheol
Yang Seung-Yeob
Cho Keun-Tae
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Abstract
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Objective: The purpose of this study is to evaluate the effect of decompressive craniectomy (DC) in patients aged 80 and over with middle cerebral artery (MCA) infarction.
Methods: We retrospectively reviewed the medical record and radiographs of 28 patients aged 80 and over with unilateral MCA infarction and National Institutes of Health Stroke Scale 18 or more with item 1a less than 2 between 2006 and 2015. We divided these patients into control group who underwent medical treatment (n=15) and DC group those who underwent DC (n=13). The outcome was measured with mortality rate and the modified Rankin scale (mRS) at 1 and 6 months, which was dichotomized between good (mRS 0-3) and poor (mRS 4-6) outcome.
Results: Mortality rate was 15.4% and 23.1% at 1 and 6 months in DC group and 33.3% and 53.3%, in control group. Statistically significant difference was not found in 1-month and 6?months mortality rate between groups (p=0.396, p=0.102, respectively). Good outcome was 7.7% and 15.4% at 1 and 6 months in DC group and 13.3% and 13.3%, respectively, in control group. Statistically significant difference was not found in 1?month and 6?months mRS between two groups (p=0.914, p=0.292, respectively).
Conclusion: In patients aged 80 and over with MCA infarction, the mortality rate is almost half in DC group compared to control group. But most survivors will have either severe or moderately severe disability. The treatment decisions should be individualized on the basis of the expectations of the patient and family.
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KEYWORD
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Decompressive craniectomy, Aged, 80 and over, Middle Cerebral Artery, Infarction
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