Clinical Analysis of Decompressive Craniectomy for Acute Massive Cerebral Infarction.
- Author:
Seok Chul KIM
1
;
Jung Kil LEE
;
Jae Sung KIM
;
Tae Sun KIM
;
Shin JUNG
;
Jae Hyoo KIM
;
Soo Han KIM
;
Sam Suk KANG
;
Je Hyuk LEE
Author Information
1. Department of Neurosurgery, Chonnam University Hospital and Medical School, Kwangju, Korea.
- Publication Type:Original Article
- Keywords:
Decompressive craniectomy;
Cerebral infarction;
Middle cerebral artery
- MeSH:
Brain Edema;
Brain Stem;
Cerebral Infarction*;
Coma;
Decompression, Surgical;
Decompressive Craniectomy*;
Female;
Glasgow Outcome Scale;
Humans;
Infarction;
Male;
Middle Cerebral Artery;
Reflex, Pupillary;
Retrospective Studies
- From:Journal of Korean Neurosurgical Society
2001;30(3):278-283
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVES: Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. METHOD: We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). RESULTS: All 15 patients(five men, ten women; mean age, 52.3 years; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale: GOS I, II), unfavorable in 6 cases(Glasgow outcome scale:GOS III, IV) and dead in 4 cases. CONCLUSION: Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.
