Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Decompressive Craniectomy for Malignant Middle Cerebral Infarction

중대뇌동맥 악성 뇌경색의 두개감압술

  • Hwang, Gyo-Jun (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Oh, Chang-Wan (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Han, Jeong-Ho (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Kim, Chae-Yong (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Kwon, O-Ki (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Park, Suk-Que (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Han, Moon-Ku (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurology, Seoul National University College of Medicine) ;
  • Bae, Hee-Joon (Clinical Neuroscience Center, Seoul National University Bundang Hospital, Department of Neurology, Seoul National University College of Medicine)
  • 황교준 (분당서울대학교병원 뇌신경센터) ;
  • 오창완 (분당서울대학교병원 뇌신경센터) ;
  • 한정호 (분당서울대학교병원 뇌신경센터) ;
  • 김재용 (분당서울대학교병원 뇌신경센터) ;
  • 권오기 (분당서울대학교병원 뇌신경센터) ;
  • 박석규 (분당서울대학교병원 뇌신경센터) ;
  • 한문구 (분당서울대학교병원 뇌신경센터) ;
  • 배희준 (분당서울대학교병원 뇌신경센터)
  • Published : 2009.06.30

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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-to-moderate 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.

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