Journal of Korean Society of Geriatric Neurosurgery 2012;8(2):145-152.
Published online December 30, 2012.
The Efficacy of Decompressive Craniectomy in Elderly Patients Older than 80 Years Old with Malignant Middle Cerebral Artery Infarction
Jae Won Yu , Hyun-Seok Park , Hyung-Dong Kim
Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
80세 이상 초고령의 악성 중대뇌동맥 경색환자에서 시행한 두개골 절제술의 효용성
유재원ㆍ박현석ㆍ김형동
동아대학교 의과대학 신경외과학교실
Abstract
Objective
There is continuing controversy about the benefit of decompressive craniectomy in elderly patients with malignant middle cerebral artery (MCA) infarction. The aim of this study was to compare the mortality rates and functional outcomes between conservative care and surgical treatment of malignant MCA infarction in elderly patients (older than 80 years of age).
Methods
Between January 2006 and May 2011, 46 patients older than 80 year of age were diagnosed with malignant MCA infarction. We retrospectively reviewed the medical records these patients, who were treated conservative care and decompressive craniectomy. Patients were divided into the conservative group and the craniectomy group. Statistical analyses were perfomed using SAS version 9.2.
Results
Mortality rates were significantly lower at 35.3% (one-month mortality rate) and 47.1% (six-month mortality rate) in the craniectomy group as compared to 69.0% and 82.8%, respectively, in the conservative care group (p=0.018, p=0.043). Preservation of pupillary light reflex, midline shift, initial NIHSS score, and extent of infarction were related with mortality rates.
Conclusions
We consider decompressive craniectomy for malignant MCA infarction as a life-saving procedure regardless of patients' age. Therefore, factors other than age should be considered and the treatment should be individualized in elderly patients with malignant infarction.
Key Words: AgeㆍCerebral infarctionㆍDecompressive craniectomyㆍMiddle cerebral arteryㆍPrognosis


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