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Journal of Korean Neurosurgical Society 1998;27(6): 770-774.
Surgical Decompression for Acute Brain Infarction.
Hyung Kyun Rha, Kyung Jin Lee, Cheol Ji, Kyung Keun Cho, Sung Chan Park, Hae Kwan Park, Dal Soo Kim, Jun Ki Kang, Chang Rak Choi
Catholic Neuroscience Center, Catholic University, Seoul, Korea.
We present 15 patients with progressive neurological deterioration while on medical treatment for massive cerebral or cerebellar edema due to large cerebral or cerebellar infarction. Clinical signs of uncal herniation were present in 10 of these patients. Remaining five patients showed progressive neurological deterioration accompanied with impending herniation. Brain CT confirmed mass effect from cerebral or cerebellar edema in all cases. All 15 patients were treated with decompressive craniectomy, duroplasty and/or ventriculostomy. Nine patients showed good results and six patients had poor results. As compared with poor result group, good result group had high score of Glass Gow Coma Scale(GCS) on admission(12.8 vs. 8.3 on average) and time from worsening to operation is shorter(8.8 vs. 21.3hrs on average). Infarction was all on right side and hearniation sign just before operation appeared infrequently in good result group. These results suggest that decompressive surgery can be effective life saving procedure for massive cerebral edema after large brain infarction, especially in cases with right side lesion, high GCS score on admission, and pertinent timing of operation(before occurrance of irreversible brain stem damage due to herniation).
Key Words: Cerebral and cerebellar infarction; Brain edema; Neurological deterioration; Decompressive surgery
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