Comparison between routine and improved decompressive craniectomy on patients with malignant cerebral artery infarction without traumatic brain injury.
BACKGROUND
Malignant cerebral artery infarction is one kind of ischemic stroke with high mortality. The aim of this study was to analyze comparatively the preoperative and postoperative clinical data as well as the prognostic factors in these patients who underwent improved decompressive craniectomy or routine decompressive craniectomy.


METHODS
A total of 131 patients with malignant cerebral artery infarction were included during the period from January 2000 to December 2012. The patients were divided into 2 groups: the improved decompressive craniectomy group (n = 85) and the routine decompressive craniectomy group (control group) (n = 46). We reviewed the detailed information of the patients; moreover, a comparative analysis of the 2 groups based on age (≤ 60 or >60 y) was performed.


RESULTS
The improved decompressive craniectomy group had a significant decrease (P < 0.05) in mortality without clinical functional improvement. The patients who were treated through routine decompressive craniectomy had a higher incidence of hydrocephalus and pulmonary infection (P = 0.011 and 0.003). Moreover, younger patients usually took less resident time in the hospital than did the patients in the elderly group (P = 0.047 vs P < 0.05). Statistical results indicated that the younger patients took a better recovery than did the elderly patients. There was a significant difference between the groups A and B both in the Barthel index and the modified Rankine scale for 3 or 6 months after discharge (P < 0.05).


CONCLUSIONS
In comparison with the routine decompressive craniectomy, the improved decompressive craniectomy can reduce the mortality rate and improve the neurologic outcome. However, it increases the incidence of encephalocele and pulmonary infection, which may cause secondary vital injury to patients after surgery. In addition, younger patients can gain a better further functional recovery by undergoing improved decompressive craniectomy.
From the Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China.
Anwen
A
Shao
Songxue
S
Guo
Sheng
S
Chen
Chongran
C
Sun
Haijian
H
Wu
Yuan
Y
Hong
Jianmin
J
Zhang
D000328:Adult; D000367:Age Factors; D000368:Aged; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis