Clinical experience analysis of standard large decompressive craniectomy and internal decompression to treat acute massive infraction decompression in large area

Yuan Jun-hui; Shi Dong-fu; Lv Yan-song; Dong Chao-feng; Zhang Shao-wei; Cui Bo

doi:10.3969/j.issn.1002-1949.2018.02.016

Abstract：Objective To analyze the clinical efficacy of standard large decompressive craniectomy and internal decompression to treat acute massive infraction decompression in large area. Methods We reviewed the clinical data of 119 patients who were diagnosed as acute massive infraction decompression in large area in our hospital from February 2013 to March 2017,in which 62 patients were treated by standard large decompressive craniectomy and internal decompression,and the rest 57 patients were treated by standard large decompressive craniectomy only. The prognosis and surgical experience were analyzed retrospectively. Results There was no difference in cerebral infarction and (Glasgow Coma Scale) GCS in two groups(P>0.05). But there was a significant difference of GCS in two groups after 7 days operation(P<0.05). After operation,43 patients survived and 14 died in standard large decompressive craniectomy group,while 53 patients survived and 9 died in standard large decompressive craniectomy and internal decompression group. According to Glasgow Outcome Score (GOS) 6 months later,1 patients recovered well, 10 patients had moderate disability, 13 patients had severe disability and 19 patients were in a vegetative state in standard large decompressive craniectomy group, while 4 patients recovered well, 16 patients had moderate disability, 23 patients had severe disability and 10 patients were in a vegetative state in standard large decompressive craniectomy and internal decompression group. The later operation can decrease mortality and disability of patients significantly than the former operation (P<0.05). Furthermore, the standard large decompressive craniectomy and internal decompression operation can reduce post-operation complication significantly in acute massive infraction decompression in large area than the only standard large decompressive craniectomy operation (P<0.05). Conclusion Standard large decompressive craniectomy and internal decompression can significantly reduce the mortality and disability of patients with acute massive cerebral infarction in large area. Early surgical intervention and full decompression should be performed to save the lives of patients, reduce post-operation complications,improve prognosis and the quality of life.