The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy

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• 作者：Tzu-Kang Lin¹ ; ^{tklin100@cgmh.org.tw" class="auth_mail" title="E-mail the corresponding author} ; Shu-Mei Chen³ ; Yin-Cheng Huang⁴ ; Pin-Yuan Chen¹ ; Min-Chi Chen⁵ ; Hong-Chieh Tsai¹ ; Tsong-Hai Lee² ; Ko-Ting Chen¹ ; Ming-Hsueh Lee⁴ ; Jen-Tsung Yang⁴ ; Kuo-Lun Huang²
• 关键词：Decompressive craniectomy ; Functional outcome ; Malignant large infarction ; Outcome predictor
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：133-138
• 全文大小：2395 K

文摘

Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors.

Methods

This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups.

Results

Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21–144.72; P < 0.001).

Conclusions

In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.