PDF(Pubmed)
Abstract：
Malignant stroke is a life-threatening emergency, with a high mortality rate (1-3). Despite strong evidence showing decreased morbidity and mortality in the adult population, decompressive hemicraniectomy (DCH) has been scarcely reported in the pediatric stroke population, and its indication remains controversial, while it could be a potential lifesaving option.
We performed an extensive literature review on pediatric malignant arterial ischemic stroke (pmAIS) and selected 26 articles reporting 97 cases. Gathering the data together, a 67% mortality rate is observed without decompressive therapy, contrasting with a 95.4% survival rate with it. The median modified Rankin score (mRS) is 2.1 after surgery with a mean follow-up of 31.8 months. For the 33% of children who survived without surgery, the mRS is 3 at a mean follow-up of 19 months. As an illustrative case, we report on a 2-year-old girl who presented a cardioembolic right middle cerebral artery stroke with subsequent malignant edema and ongoing cerebral transtentorial herniation in the course of a severe myocarditis requiring ECMO support. A DCH was done 32 h after symptom onset. At the age of 5 years, she exhibits an mRS of 3.
Pediatric stroke with malignant edema is a severe condition with high mortality rate if left untreated and often long-lasting consequences. DCH might minimize the vicious circle of cerebral swelling, increasing intracranial pressure and brain ischemia. Our literature review underscores DCH as an efficient therapeutic measure management of pmAIS even when performed after a significant delay; however, long-lasting morbidities remain high.
We performed an extensive literature review on pediatric malignant arterial ischemic stroke (pmAIS) and selected 26 articles reporting 97 cases. Gathering the data together, a 67% mortality rate is observed without decompressive therapy, contrasting with a 95.4% survival rate with it. The median modified Rankin score (mRS) is 2.1 after surgery with a mean follow-up of 31.8 months. For the 33% of children who survived without surgery, the mRS is 3 at a mean follow-up of 19 months. As an illustrative case, we report on a 2-year-old girl who presented a cardioembolic right middle cerebral artery stroke with subsequent malignant edema and ongoing cerebral transtentorial herniation in the course of a severe myocarditis requiring ECMO support. A DCH was done 32 h after symptom onset. At the age of 5 years, she exhibits an mRS of 3.
Pediatric stroke with malignant edema is a severe condition with high mortality rate if left untreated and often long-lasting consequences. DCH might minimize the vicious circle of cerebral swelling, increasing intracranial pressure and brain ischemia. Our literature review underscores DCH as an efficient therapeutic measure management of pmAIS even when performed after a significant delay; however, long-lasting morbidities remain high.
摘要：
目的：恶性卒中是危及生命的急症，死亡率高（1-3）。尽管有强有力的证据表明成年人的发病率和死亡率下降，大骨瓣减压术（DCH）在小儿中风人群中几乎没有报道，它的指示仍然存在争议，虽然这可能是一个潜在的救命选择。
结果：我们对儿童恶性动脉缺血性卒中（pmAIS）进行了广泛的文献综述，并选择了26篇报告97例病例的文章。把数据收集在一起,在没有减压治疗的情况下观察到67%的死亡率，与之形成鲜明对比的是它的95.4%的存活率。手术后中位改良Rankin评分（mRS）为2.1，平均随访31.8个月。对于没有手术存活的33%的儿童来说，平均随访19个月时，mRS为3。作为一个说明性案例，我们报道了一名2岁女孩,她在需要ECMO支持的严重心肌炎过程中出现心源性右大脑中动脉卒中,随后出现恶性水肿和持续的脑小脑幕疝.症状发作后32小时进行DCH。在5岁的时候，她的mRS为3。
结论：伴恶性水肿的小儿卒中是一种严重的疾病，如果不及时治疗，死亡率很高，而且往往是长期的后果。DCH可能会减少脑肿胀的恶性循环，颅内压升高和脑缺血。我们的文献综述强调DCH是一种有效的pmAIS治疗措施，即使在明显延迟后进行；然而，长期发病率仍然很高。
结果：我们对儿童恶性动脉缺血性卒中（pmAIS）进行了广泛的文献综述，并选择了26篇报告97例病例的文章。把数据收集在一起,在没有减压治疗的情况下观察到67%的死亡率，与之形成鲜明对比的是它的95.4%的存活率。手术后中位改良Rankin评分（mRS）为2.1，平均随访31.8个月。对于没有手术存活的33%的儿童来说，平均随访19个月时，mRS为3。作为一个说明性案例，我们报道了一名2岁女孩,她在需要ECMO支持的严重心肌炎过程中出现心源性右大脑中动脉卒中,随后出现恶性水肿和持续的脑小脑幕疝.症状发作后32小时进行DCH。在5岁的时候，她的mRS为3。
结论：伴恶性水肿的小儿卒中是一种严重的疾病，如果不及时治疗，死亡率很高，而且往往是长期的后果。DCH可能会减少脑肿胀的恶性循环，颅内压升高和脑缺血。我们的文献综述强调DCH是一种有效的pmAIS治疗措施，即使在明显延迟后进行；然而，长期发病率仍然很高。
