중증 대뇌동맥 경색 환자에서 두개감압술 후의 기능적 예후
Functional Outcomes of Patients with Severe MCA Infarction after Decompressive Craniectomy
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Objective: To compare the functional outcomes between surgical treatment and conservative medicaltreatment for severe middle cerebral artery (MCA) infarction. Method: This is comparative analysis of prospectively documented data with 25 patients have malignantMCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such asdecompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservativemedical treatment. We defined MCA infarction as “severe” when it concerned both the deep andsuperficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75on admission to our department. Functional status was measured using modified Rankin Scale (mRS),FIM, Motricity Index (MI) and Trunk Control Test (TCT). All evaluations were measured at baselineand 90 days after stroke. Results: Mean age were 55.0 ± 8.6 and 58.7 ± 12.3 in Group A and B. Rt. MCA infarction were4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baselinefunctional status between two groups was not significantly different. Each group showed functionalimprovement according to the time. When compared changes between two groups, arm Motricity Index,K-MMSE, mRS and FIM were no significant difference between two groups. Leg segments of MI andTCT was significantly improved in Group A more than B at 90 days after baseline evaluation (p＜0.05). Conclusion: Decompressive craniectomy improved motor function of affected leg and trunk in patientswith severe MCA infarction more than conservative medical treatment alone.
Abstract
Objective: To compare the functional outcomes between surgical treatment and conservative medicaltreatment for severe middle cerebral artery (MCA) infarction. Method: This is comparative analysis of prospectively documented data with 25 patients have malignantMCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such asdecompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservativemedical treatment. We defined MCA infarction as “severe” when it concerned both the deep andsuperficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75on admission to our department. Functional status was measured using modified Rankin Scale (mRS),FIM, Motricity Index (MI) and Trunk Control Test (TCT). All evaluations were measured at baselineand 90 days after stroke. Results: Mean age were 55.0 ± 8.6 and 58.7 ± 12.3 in Group A and B. Rt. MCA infarction were4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baselinefunctional status between two groups was not significantly different. Each group showed functionalimprovement according to the time. When compared changes between two groups, arm Motricity Index,K-MMSE, mRS and FIM were no significant difference between two groups. Leg segments of MI andTCT was significantly improved in Group A more than B at 90 days after baseline evaluation (p＜0.05). Conclusion: Decompressive craniectomy improved motor function of affected leg and trunk in patientswith severe MCA infarction more than conservative medical treatment alone.
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