| 英文摘要 |
Massive supratentorial infarctions are often associated with severe brain swelling and death secondary to herniation. Contemporary treatment modalities involving hyperventilation, osmodiuretic agents, and steroids are frequently ineffective in reducing the acute cerebral edema that follows infarction. Decompressive craniectomy provides a new method for prevention of uncal herniation. However, the of patients receiving this operation, clinical outcome, the criteria for patient selection, and the optional timing of surgery are still controversial. We report a retrospective series of nine patients presented with who progressive neurologic deterioration during medical therapy for large hemispheric infarct. Four patients of these patients had dominant hemisphere infarction. Author eleven patients were treated conservatively as a control group. Pre- and post-ictal Canadian Neurological Scale scores were recorded and the functional recovery was evaluated the Barthel index. Seven of the nine surgically treated patients demonstrated neurologic improvement on the seventh postoperative day. All of them survived and regained consciousness later. After rehabilitation training, three patients were functionally independent while two were severely disabled. Patients with dominant hemisphere infarct recovered as well as those with stroke in non-dominant hemisphere, though motor aphasia was inevitable left. In the control group,. Four patients died of uncal herniation, three were bed-ridden with cloudy consciousness, and the others achieved neurological improvement. For patients with massive supratentorial infarction, decompressive surgery is effective in life-saving but caution should be exercised in selecting candidates to achieve a favorable outcome. |
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