Journal of Korean Society of Geriatric Neurosurgery 2015;11(1):19-23.
Published online June 30, 2015.
Factors Affecting the Result of Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction
Myung Hoon Kim , Dong Am Park , Seok Won Kim , Sang Woo Ha
Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
악성 중대뇌동맥 경색에서 감압적 두개골 절제술 결과에 영향을 미치는 요인
김명훈·박동암·김석원·하상우
조선대학교 의과대학 신경외과학교실
Abstract
Objective
Acute cerebral infarction, especially middle cerebral artery (MCA) infarction, can lead to cerebral edema, increasing intracranial pressure and herniation of brain which can be fatal. The purpose of this study was to evaluate the prognostic factors in patients with malignant MCA infarction who underwent decompressive craniectomy during ongoing brain herniation.
Methods
From January 2008 to June 2014, we retrospectively reviewed 56 patients with malignant MCA infarction who received decompressive craniectomy for ongoing brain herniation. We divided the patients into two groups according to the functional outcome (Group I: 23 patients showing good result, Barthel index ≥60, Group II: 33 patients showing poor result, Barthel index <60 including death). Patients were evaluated based on the age, location of infarction, National Institute of Health Stroke Scale (NIHSS) at admission, preoperative Glasgow coma scale (GCS).
Results
All patients underwent decompressive craniectomy with wide duroplasty. Good result group (Group I) was significantly younger than poor result group (Group II). Right side involvement and higher GCS level before surgery were also main factors affecting the acceptance of decompressive craniectomy in patients with a malignant MCA infarction. But NIHSS score at admission was not significant factor for functional outcome.
Conclusion
Younger age, higher preoperative GCS score and right side involvement are main favorable factors which should be considered in predicting patients prognosis of decompressive craniectomy for malignant MCA infarction.
Key Words: InfarctionㆍDecompressive craniectomyㆍOutcomes


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