Journal of Korean Society of Geriatric Neurosurgery 2016;12(2):206-211.
Published online September 30, 2016.
The Effect of Decompressive Craniectomy in Elderly Patients Aged 80 and Over with Middle Cerebral Artery Infarction
Hokyun Han , Eun Jung Koh , Hyunho Choi , Byong-Cheol Kim , Seung Yeob Yang , Keun-Tae Cho
Department of Neurosurgery, Dongguk University, Seoul, Korea and Dongguk University Ilsan Hospital, Goyang, Korea
80세 이상 노인 중대뇌동맥 뇌경색 환자에서 감압 개두술의 효과에 관한 연구
한호균·고은정·최현호·김병철·양승엽·조근태
동국대학교 일산병원 신경외과학교실
Abstract
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.
Key Words: Decompressive craniectomy, Aged, 80 and over, Middle Cerebral Artery, Infarction


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