Clinical efficacy of internal decompression based on white matter tract preservation in treatment of malignant middle cerebral artery infarction
10.3969/j.issn.1002-0152.2025.10.003
- VernacularTitle:基于白质纤维束保护的内减压术治疗恶性大脑中动脉梗死临床疗效
- Author:
Yanli ZHANG
1
;
Menglu LI
;
Jiankai ZHAO
;
Jingmin DOU
;
Fei ZHANG
;
Baoming JIA
;
Guoqiang FENG
;
Hongbin KU
Author Information
1. 河北省邢台市中心医院神经外科(邢台 054000)
- Publication Type:Journal Article
- Keywords:
Malignant middle cerebral artery infarction;
Infarct core;
Corticospinal tract;
Neuro-navigation;
Vi-sual Model;
Internal decompression
- From:
Chinese Journal of Nervous and Mental Diseases
2025;51(10):596-600
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of internal decompression based on white matter tract preservation in the treatment of malignant middle cerebral artery infarction(MMCAI).Methods A retrospective analysis was conducted on 54 patients with MMCAI.Patients were divided into a study group(n=26)and a control group(n=28)according to the surgical approach.Patients in the study group underwent preoperative fusion of CT,CTP,DWI,and DTI imaging data within a neuronavigation system.This fusion visualized the spatial relationships between the infarct core(IC),ischemic penumbra,and the corticospinal tract(CST).Subsequently,IC resection combined with decompressive craniectomy(DC)was performed while protecting the CST.Patients in the control group underwent DC alone.Key outcome measures included:changes in fractional anisotropy(FA)within the affected CST projection area at 1 month postoperatively;and 6-month postoperative mRS score,mortality,and surgical complications at 6 months postoperatively.Results At 1 month postoperatively,FA in the affected CST projection area were significantly higher in the study group than in the control group(0.092±0.013 vs.0.082±0.008,P<0.05).At the 6-month follow-up,the postoperative mRS score in the study group was significantly lower than that in the control group[2.3(1.3,4.5)vs.3.9(2.4,5.5),P<0.05]and a lower mortality rate(11.5%vs.39.3%,P<0.05)compared to the control group.However,there were no statistically significant differences between the two groups in the incidence of postoperative intracranial hemorrhage,intracranial infection,or epilepsy(P>0.05).Conclusion Internal decompression based on white matter tract protection combined with DC can reduce mortality and contribute to improving function outcomes in patients with MMCAI.
