ABSTRACT
Objective@#To investigate the efficacy and safety of cuboid stereotactic aspiration of necrotic brain tissue for treating malignant middle cerebral artery infarction in the elderly patients.@*Methods@#Sixteen elderly patients with malignant middle cerebral artery infarction were selected from June 2017 to January 2019 in our hospital. Patients were followed up for 6 months to evaluate the efficacy of stereotactic aspiration of necrotic brain tissue using the modified Rankin Scale (mRS).@*Results@#The 30-day mortality was 18.75%. Among the 16 elderly patients, 6 (37.5%) had an mRS score of 3 (defined as moderate disability), 6 (37.5%) had an mRS score of 4 (defined as moderate to severe disability), 1 (6.25%) had an mRS score of 5 (defined as severe disability), and 3 (18.75%) had an mRS score of 6. The probability of 6-month favorable outcome, defined as an mRS score of ≤3, was 37.5%, and the 6-month mortality was 18.75%.@*Conclusions@#It is a simple, minimally invasive, effective and safe method to treat malignant middle cerebral artery infarction in the elderly patients with cuboid stereotactic aspiration of necrotic brain tissue, which needs to be confirmed by further randomized controlled studies.
ABSTRACT
Objective To investigate the efficacy and safety of cuboid stereotactic aspiration of necrotic brain tissue for treating malignant middle cerebral artery infarction in the elderly patients.Methods Sixteen elderly patients with malignant middle cerebral artery infarction were selected from June 2017 to January 2019 in our hospital.Patients were followed up for 6 months to evaluate the efficacy of stereotactic aspiration of necrotic brain tissue using the modified Rankin Scale (mRS).Results The 30-day mortality was 18.75％.Among the 16 elderly patients,6 (37.5％) had an mRS score of 3 (defined as moderate disability),6 (37.5％) had an mRS score of 4 (defined as moderate to severe disability),1 (6.25％) had an mRS score of 5 (defined as severe disability),and 3 (18.75％) had an mRS score of 6.The probability of 6-month favorable outcome,defined as an mRS score of ≤ 3,was 37.5％,and the 6-month mortality was 18.75％.Conclusions It is a simple,minimally invasive,effective and safe method to treat malignant middle cerebral artery infarction in the elderly patients with cuboid stereotactic aspiration of necrotic brain tissue,which needs to be confirmed by further randomized controlled studies.
ABSTRACT
A large ischemic stroke caused by malignant middle cerebral artery infarction can lead to severe cerebral edema, even cerebral hernia. This condition deteriorates and progresses rapidly, usually leading to death. Due to limitations of conservative treatments, decompressive hemicraniectomy becomes a favored option in clinic. Recent years, a series of ex?perimental studies and clinical trials achieved reliable evidence that decompressive hemicraniectomy is an effective treat?ment for patients who suffer from malignant middle cerebral artery infarction. With the successful surgical procedure, most patients benefit from a reduced mortality and improved functional outcome without severe disability. Nevertheless, plenty of issues about decompressive hemicraniectomy still need to be solved. Here, we reviewed researches of early diagnosis of ma?lignant middle cerebral infarction and the application of decompressive hemicraniectomy as its treatment.
ABSTRACT
Decompressive craniectomy is used to treat increased intracranial pressure due to brain swelling in middle cerebral artery infarction. Recently, 3 European multicenter, prospective, randomized trials and a pooled analysis were published. In the pooled analysis, decompressive craniectomy did not appear to increase the risk of complete dependency, misery, and hopelessness. Exactly 2 patients in the surgical and medical groups (5%) were bedbound and severely disabled (mRS 5) at 1 year. The proportion of patients alive with minimal-tomoderate disability (mRS 0-3), however, was significantly increased from 21% to 43%. Decompressive craniectomy resulted in a 49% absolute risk reduction in death, and an absolute increase in the proportion of patients rated as mRS 2 of 12%, mRS 3 of 10%, and mRS 4 of 29%. But, this can be applied in cases with relative young age and early surgical procedure. Therefore, the indication for decompressive craniectomy should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.