Clinical study of minimally invasive decompression in the treatment of malignant middle cerebral artery infarction

doi:10.3969/j.issn.1006-7795.2018.04.013

Abstract

Abstract: Objective To study the effect of minimally invasive decompression on the treatment of malignant middle cerebral artery infarction. Method There were 13 cases under minimally invasive decompression in the treatment of massive cerebral infarction from December 2012 to December 2016 in our department, 4 male cases, 9 female cases, and aged from 22 to 85 years old, of which 6 cases with patients older than 60 years. The telephone follow-up was conducted at 180th day after the attack, and the modified Rankin cale (mRS) was used to evaluate prognosis. mRS ≤ 2 scored favorable prognosis, mRS>2 scored unfavorable prognosis. Result 4 cases among 13 cases died from cerebral hernia and associated severe complications, and the death rate was 30.8%. 1 case died from massive hemorrhage of upper gastrointestinal tract gallstones. There were 5 cases of mRS ≤ 2, and 3 cases of mRS>2 among 8 survivor cases. There was no complication, such as intracranial infection, hemorrhage or subdural hematoma. Conclusion Minimally invasive decompression in the treatment of malignant middle cerebral artery infarction decreased significantly the death rate. This method was simple, fast, safe, and effective, without age limit and complication.

Key words: malignant middle cerebral artery infarction, minimally invasive decompression, brain edema, cerebral swelling

CLC Number:

R743.31

Hou Huanfeng, Li Rujuan, Ma Xiaohui, Yang Jinbo. Clinical study of minimally invasive decompression in the treatment of malignant middle cerebral artery infarction[J]. Journal of Capital Medical University, 2018, 39(4): 546-551.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2018.04.013

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2018/V39/I4/546

References

[1] Hacke W, Schwab S, Horn M, et al. ‘Malignant’ middle cerebral artery territory infarction:clinical course and prognostic signs[J]. Arch Neurol,1996, 53(4):309-315.
[2] Berrouschot J, Sterker M, Bettin S, et al. Mortality of space-occupying (‘malignant’) middle cerebral artery infarction under conservative intensive care[J]. Intensive Care Med,1998, 24(6):620-623.
[3] Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery:a pooled analysis of three randomised controlled trials[J].Lancet Neurol, 2007, 6(3):215-222.
[4] Huttner H B, Schwab S. Malignant middle cerebral artery infarction:clinical characteristics, treatment strategies, and future perspectives[J]. Lancet Neurol, 2009, 8(10):949-958.
[5] Neugebauer H, Juttler E. Hemicraniectomy for malignant middle cerebral artery infarction:current status and future directions[J]. Int J Stroke,2014, 9(4):460-467.
[6] Staykov D, Gupta R. Hemicraniectomy in malignant middle cerebral artery infarction[J]. Stroke,2011, 42(2):513-516.
[7] Heiss W D. Malignant MCA infarction:pathophysiology and imaging for early diagnosis and management decisions[J].Cerebrovasc Dis, 2016, 41(1-2):1-7.
[8] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志,2010, 43(2):146-153.
[9] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志,2015, 48(4):246-257.
[10] Taylor B, Lopresti M, Appelboom G, et al. Hemicraniectomy for malignant middle cerebral artery territory infarction:an updated review[J]. J Neurosurg Sci, 2015, 59(1):73-78.
[11] Frank J I. Large hemispheric infarction, deterioration, and intracranial pressure[J]. Neurology, 1995, 45(7):1286-1290.
[12] Dostovic Z, Dostovic E, Smajlovic D,et al. Brain edema after ischaemic stroke[J]. Med Arch, 2016. 70(5):339-341.
[13] Howard B M, Barrow D L. Decompressive hemicraniectomy for malignant middle cerebral artery infarction:are we shepherds or wolves[J]. World Neurosurg,2015,83(4):473-476.
[14] Kamal A B, Bukhari A S, Assad S, et al. Functional outcome after decompressive craniectomy in patients with dominant or non-dominant malignant middle cerebral infarcts[J]. Cureus, 2017, 9(1):e997.
[15] 杨金波, 侯焕峰, 马晓辉,等. 微创减压治疗恶性大脑中动脉脑梗死[J]. 中华神经科杂志,2013, 46(11):779-781.
[16] Qureshi A I, Suarez J I, Yahia A M, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction:a multicenter review[J]. Crit Care Med, 2003, 31(1):272-277.
[17] Yu W, Rives J, Welch B,et al. Hypoplasia or occlusion of the ipsilateral cranial venous drainage is associated with early fatal edema of middle cerebral artery infarction[J]. Stroke, 2009, 40(12):3736-3739.
[18] Zhang J H. Vascular neural network in subarachnoid hemorrhage[J]. Transl Stroke Res,2014, 5(4):423-428.
[19] Chen S, Chen Y, Xu L, et al. Venous system in acute brain injury:Mechanisms of pathophysiological change and function[J]. Exp Neurol, 2015, 11(272):4-10.
[20] Chen Y, Li Q, Tang J, et al.The evolving roles of pericyte in early brain injury after subarachnoid hemorrhage[J]. Brain Res, 2015, 14(1623):110-122.
[21] 董晓辉, 徐跃峤,程玮涛,等.开颅减压手术治疗恶性脑静脉血栓九例报告[J].中国脑血管病杂志,2016,13(3):140-145.