恶化型大脑半球大面积梗死的手术适应证及疗效分析

Surgical decompression for patients with deteriorating massive hemispheric infarction:indications and results

目的 探讨恶化型大脑半球大面积梗死的手术适应症并分析其疗效。方法 15例恶化型大脑半球大面积梗死应用标准脑外伤大骨瓣开颅术进行回顾性分析。结果 术后CT复查均见脑组织从减压窗膨出,中线结构移位减轻,基底池闭塞好转。15例均得到随访,恢复良好3例,轻、中残6例,重残4例,死亡2例,死亡率为13.3％。结论 恶化型大脑半球大面积梗死只要出现意识恶化,CT见完全性大脑中动脉梗死,继发脑水肿并有中线移位和基底池受压,无其他器官的严重病变即应采取积极的手术治疗。标准脑外伤大骨瓣开颅术能缓解大面积大脑梗死继发的颅内高压,对术前已有脑疝形成的病人行内减压并小脑幕切开术能改善病人的预后。

Objective To explore the indications and the effects of decompressive craniotomy for patients with deteriorating massive hemispheric infarction Methods 15 cases admitted to our department with massive hemispheric infarction and treated by standard large trauma craniotomy were analyzed retrospectively. Results All CT scans after surgical decompression showed the edematous tissue outside the cranial vault and reversing shifts. Among 15 cases, 3 cases had a good recovery, 6 mild and moderate disability, 4 severe disability, and 2 died after therapy. Conclusion Surgical decompression should be performed as soon as possible if the consciousness is deteriorating and meanwhile the CT scan shows a complete MCA infarction with displacement of the midline. The standard large trauma craniotomy is the best management to release the secondary intracranial high pressure by massive hemispheric edema. The prognosis can be improved by performing tentorium cerebelli hiatus in those cases with complicated cranial herniation.