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J Neurocrit Care 2008;1(2): 157-163.
Decompressive Hemicraniectomy for Brain Herniation in Malignant Middle Cerebral Artery Infarction: Outcomes of 21 Patients
Hyun Cho, MD1, Jae Hyeon Park, MD2, Yong Soon Hwang, MD3, Sang Won Han, MD2, Joong Hyun Park, MD2, Jee-Hyun Kwon, MD1 and Hyun-Jin Seo, MD1
1Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea 2Departments of Neurology, 3Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea, 2Departments of Ne
Decompressive Hemicraniectomy for Brain Herniation in Malignant Middle Cerebral Artery Infarction: Outcomes of 21 Patients
Hyun Cho, MD1 Jae Hyeon Park, MD2, Yong Soon Hwang, MD3, Sang Won Han, MD2, Joong Hyun Park, MD2, Jee-Hyun Kwon, MD1 and Hyun-Jin Seo, MD1
1Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea 2Departments of Neurology, 3Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea, 2Departments of Ne
ABSTRACT
Background: Acute infarction of the middle cerebral artery (MCA) can lead to severe cerebral edema, raised intracranial pressure (ICP) and cerebral herniation, which may result in coma and death. Decompressive hemicraniectomy is an effective, life saving treatment for these patients.
Methods: We enrolled the patients with malignant MCA infarction from January 2000 to August 2004 in our hospital. Data collected included demographic informations, time from the symptom onset to decompressive hemicraniectomy, mortality rate, prognosis, stroke risk factors and stroke type. Clinical status was recorded on admission and on the 7th postoperative day. Each patient had a baseline and follow up CT scan within 48 hours. We compared the outcomes of patients with malignant MCA infarction who underwent decompressive hemicraniectomy with those of patients who had conservative treatment and also with the previously published data.
Results: During that period, twenty-one patients underwent decompressive hemicraniectomy due to impending herniation despite the appropriate medical treatment. The mean age of the patients was 55±15 years old. The time interval from the symptom onset to hemicraniectomy was 33±8 hours. Among them, seven patients (33%) were expired. Eighteen patients, who treated only conservative treatment, the mean age was 74±6 and five (28%) patients were expired.
Conclusions: In patients with malignant MCA infarction, decompressive hemicraniectomy should be performed in younger patients within early stage considering mortality rate and prognosis. Making criteria of decompressive hemicraniectomy including imaging modalities and clinical evaluation is needed for early detection.
Key Words: Decompressive hemicraniectomy·Malignant middle cerebral artery infarction·Brain herniation
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