TREATMENT OF RIGHT HEMISPHERIC CEREBRAL INFARCTION BY HEMICRANIECTOMY
TREATMENT OF RIGHT HEMISPHERIC CEREBRAL INFARCTION BY HEMICRANIECTOMY
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DOI：
10.1161/01.str.21.6.874
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发表时间：
1990-06-01
期刊：
影响因子：
8.3
通讯作者：
GRADY, MS
中科院分区：
文献类型：
--
作者：
DELASHAW, JB;BROADDUS, WC;GRADY, MS
9名患者(3名男性和6名女性，平均年龄57岁)在接受药物治疗时出现进行性的神经恶化，这是一组轶事。这9例患者中有7例出现钩状突出的临床体征(角膜不均匀或瞳孔固定和扩大，和/或左侧偏瘫伴右侧去大脑姿势)。头部的计算机断层扫描证实了脑水肿的肿块效应。治疗神经科医生和神经外科医生的临床判断是，除非对脑梗塞进行手术减压，否则这9名患者中的每一位都会死亡。相应地，每个人都接受了右半颅骨切除和硬脑膜扩大术。6名患者在术后第一天表现出神经功能改善。一名术后确诊为肺癌的患者在手术后1个月死亡。其余8名患者目前与家人同住，随访期从5个月到25个月不等。通过Barthel指数评估的患者结果表明，有3名患者在最低限度的帮助下可以正常工作，其余6名患者在功能上是依赖的。经过康复治疗后，4名患者返回进行择期颅骨成形术。这些结果表明，对于大面积脑梗塞后的恶性脑水肿，半脑切除是一种有效的挽救生命的方法。
An anecdotal series of nine patients (three men and six women with an average age of 57 years) presented with progressive neurologic deterioration while on medical therapy for large right hemispheric cerebral infarction. Clinical signs of uncal herniation (anisocoria or fixed and dilated pupils, and/or left hemiplegia with right decerebrate posturing) were present in seven of these nine patients. Computerized tomography of the head confirmed mass effect from cerebral edema. It was the clinical judgment of the treating neurologists and neurosurgeons that each of these nine patients would perish unless surgical decompression of the infarcted brain was performed. Accordingly, each was treated with right hemicraniectomy and dural augmentation. Six patients demonstrated neurologic improvement on the first postoperative day. One patient, with a postoperative diagnosis of lung cancer, died 1 month after surgery. The remaining eight patients are currently living with their families with a follow-up period ranging from 5 to 25 months. Patient outcome as evaluated by the Barthel Index indicates that three individuals are functioning with minimal assistance and that the remaining six patients are functionally dependent. After rehabilitative therapy, four patients returned for elective cranioplasty. These results suggest that hemicraniectomy can be an effective lifesaving procedure for malignant cerebral edema after large hemisphere infarction.