Decompressive Craniectomy for Malignant Middle Cerebral Infarction.
- Author:
Gyojun HWANG
1
;
Chang Wan OH
;
Jeong Ho HAN
;
Chae Yong KIM
;
O Ki KWON
;
Suk Que PARK
;
Moon Ku HAN
;
Hee Joon BAE
Author Information
1. Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine, Bundang, Korea. wanoh@snu.ac.kr
- Publication Type:Multicenter Study ; Review
- Keywords:
Decompressive craniectomy;
Malignant middle cerebral artery infarction;
Intracranial hypertension
- MeSH:
Brain Edema;
Caregivers;
Cerebral Infarction;
Decompressive Craniectomy;
Dependency (Psychology);
Humans;
Infarction, Middle Cerebral Artery;
Intracranial Hypertension;
Intracranial Pressure;
Numbers Needed To Treat
- From:Korean Journal of Cerebrovascular Surgery
2009;11(2):49-54
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Decompressive craniectomy is used to treat increased intracranial pressure due to brain swelling in middle cerebral artery infarction. Recently, 3 European multicenter, prospective, randomized trials and a pooled analysis were published. In the pooled analysis, decompressive craniectomy did not appear to increase the risk of complete dependency, misery, and hopelessness. Exactly 2 patients in the surgical and medical groups (5%) were bedbound and severely disabled (mRS 5) at 1 year. The proportion of patients alive with minimal-tomoderate disability (mRS 0-3), however, was significantly increased from 21% to 43%. Decompressive craniectomy resulted in a 49% absolute risk reduction in death, and an absolute increase in the proportion of patients rated as mRS 2 of 12%, mRS 3 of 10%, and mRS 4 of 29%. But, this can be applied in cases with relative young age and early surgical procedure. Therefore, the indication for decompressive craniectomy should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.
