恶性大脑中动脉区梗死的外科处理

Surgical Management for Malignant Middle Cerebral Artery Infarction

恶性大脑中动脉区梗死占所有大脑中动脉区梗死的15%～20%.一些患者会出现占位性脑水肿而导致中线结构移位、颅内压增高和脑疝形成.通常在症状出现后2～5 d内意识水平下降和出现脑干体征而恶化.内科保守治疗的病死率高达60%～80%,而积极手术治疗却能显著降低病死率并改善预后.

Malignant middle cerebral artery (MCA) infarction comprises 15-20% of all MCA infarctions. Some patients may develop a space-occupying brain edema leading to raised intracranial pressure, midline shift, and in the worst case, herniation with subsequent death. Clinical deterioration with decreasing levels of consciousness and evolvement of brain stem signs usually occurs within 2 to 5 days following symptom onset. The mortality of conservative treatment is as high as 60-80%, while the aggressive surgical management may significantly reduce the mortality and improve their prognosis.