Abstract：
BACKGROUND: Malignant middle cerebral artery infarction (mMCA) is a devastating disease with rates of fatality as high as 80%. Decompressive hemicraniectomy (DHC) reduces mortality, but many survivors inevitably remain severely disabled. This study aimed to analyze patients with mMCA undergoing DHC or best medical treatment (BMT) baseline characteristics and factors linked to therapeutic choice and determinants of prognosis.
METHODS: We recorded clinical and radiological features of patients undergoing BMT or DHC. The two groups were compared for epidemiology, clinical presentation, neuroimaging, and prognosis. Regression analysis was performed to identify predictors of surgical treatment and outcome.
RESULTS: One hundred twenty-five patients were included (age 67.41 ± 1.39 yo; 65 M). Patients undergoing DHC (N = 57) were younger (DHC 55.71 ± 1.48 yo vs. BMT 77.22 ± 1.38) and had midline shift (DHC 96.5% (55/57) vs. BMT 35.3% (24/68), a larger volume of the affected hemisphere and reduced ventricles volume as compared to BMT. The chance of surgery depended on age (Exp(B) = 0.871, p < 0.001), clinical status at onset (NIHSS Exp(B) = 0.824, p = 0.030) and volume of the ventricle of the affected hemisphere (Exp(B) = 0.736, p = 0.006). Death rate during admission was significantly lower for DHC (DHC 15% (6/41) vs BMT 71.7% (38/53), Fisher\'s test = 30.234, p < 0.001).
CONCLUSIONS: Although DHC may cause prolonged hospitalization and long-term disabled patients, it is a lifesaving therapy that should be considered for selected patients with mMCA but perioperative complications and cost-utility should be considered. Patients and families should be correctly counseled about this therapeutic choice and its short- and long-term consequences.
METHODS: We recorded clinical and radiological features of patients undergoing BMT or DHC. The two groups were compared for epidemiology, clinical presentation, neuroimaging, and prognosis. Regression analysis was performed to identify predictors of surgical treatment and outcome.
RESULTS: One hundred twenty-five patients were included (age 67.41 ± 1.39 yo; 65 M). Patients undergoing DHC (N = 57) were younger (DHC 55.71 ± 1.48 yo vs. BMT 77.22 ± 1.38) and had midline shift (DHC 96.5% (55/57) vs. BMT 35.3% (24/68), a larger volume of the affected hemisphere and reduced ventricles volume as compared to BMT. The chance of surgery depended on age (Exp(B) = 0.871, p < 0.001), clinical status at onset (NIHSS Exp(B) = 0.824, p = 0.030) and volume of the ventricle of the affected hemisphere (Exp(B) = 0.736, p = 0.006). Death rate during admission was significantly lower for DHC (DHC 15% (6/41) vs BMT 71.7% (38/53), Fisher\'s test = 30.234, p < 0.001).
CONCLUSIONS: Although DHC may cause prolonged hospitalization and long-term disabled patients, it is a lifesaving therapy that should be considered for selected patients with mMCA but perioperative complications and cost-utility should be considered. Patients and families should be correctly counseled about this therapeutic choice and its short- and long-term consequences.
摘要：
背景：恶性大脑中动脉梗死（mMCA）是一种破坏性疾病，致死率高达80％。减压半切除术（DHC）降低死亡率，但是许多幸存者不可避免地仍然严重残疾。本研究旨在分析接受DHC或最佳药物治疗（BMT）的mMCA患者的基线特征以及与治疗选择和预后决定因素相关的因素。
方法：我们记录了接受BMT或DHC的患者的临床和放射学特征。比较两组的流行病学,临床表现,神经影像学,和预后。进行回归分析以确定手术治疗和结果的预测因素。
结果：纳入125例患者（年龄67.41±1.39yo;65M）。接受DHC的患者（N=57）更年轻（DHC55.71±1.48yovs.BMT77.22±1.38），中线移位（DHC96.5％（55/57）与BMT35.3%（24/68），与BMT相比，受影响的半球体积更大，心室体积减少。手术的机会取决于年龄（Exp（B）=0.871，p<0.001），发病时的临床状态（NIHSSExp（B）=0.824，p=0.030）和受影响半球的心室容积（Exp（B）=0.736，p=0.006）。DHC入院时死亡率显著降低（DHC15%（6/41）vsBMT71.7%（38/53），费希尔检验=30.234，p<0.001)。
结论：虽然DHC可能导致长期住院和长期残疾患者，对于部分mMCA患者,这是一种挽救生命的治疗方法,但应考虑围手术期并发症和成本效用.患者和家庭应该正确地咨询这种治疗选择及其短期和长期的后果。
方法：我们记录了接受BMT或DHC的患者的临床和放射学特征。比较两组的流行病学,临床表现,神经影像学,和预后。进行回归分析以确定手术治疗和结果的预测因素。
结果：纳入125例患者（年龄67.41±1.39yo;65M）。接受DHC的患者（N=57）更年轻（DHC55.71±1.48yovs.BMT77.22±1.38），中线移位（DHC96.5％（55/57）与BMT35.3%（24/68），与BMT相比，受影响的半球体积更大，心室体积减少。手术的机会取决于年龄（Exp（B）=0.871，p<0.001），发病时的临床状态（NIHSSExp（B）=0.824，p=0.030）和受影响半球的心室容积（Exp（B）=0.736，p=0.006）。DHC入院时死亡率显著降低（DHC15%（6/41）vsBMT71.7%（38/53），费希尔检验=30.234，p<0.001)。
结论：虽然DHC可能导致长期住院和长期残疾患者，对于部分mMCA患者,这是一种挽救生命的治疗方法,但应考虑围手术期并发症和成本效用.患者和家庭应该正确地咨询这种治疗选择及其短期和长期的后果。
