The Comparison Of Medical Treatment And Surgical Therapy On Massive Hemispheric Infarction And Investigation Of The Factors Affecting The Outcome Of Decompressive Craniectomy

Objective: To investigate the factors affecting the patients' survival rate and quality of life after decompressive craniectomy because of massive hemispheric infarction and to seek suitable patients in order to decrease mortality and improve the outcome avoiding unnecessary invasive treatment. Through contrasting the decompressive craniectomy and medical treatment, the therapeutic effect of the two treaments were analysised.Method:The mortality ,overall prognosis and disability of 66 patients who were operated on decompressive craniectomy and 52 patients by medical treatment because of massive hemispheric infarction were analysised. According to age(60 years),we grouped the patients who had massive hemispheric infarction into two groups(above 60 years and below 60 years) and analysised the mortality ,overall prognosis and disability between operative patients and medical treatment patients in each group. The factors affecting the mortality and overall prognosis after decompressive craniectomy,such as age,the infarction volume on CT and the displace of mean line on CT before operation ,the NIHSS score before operation,the interval between operation and stroke, pathogeny, left and right hemisphere , whether the patients were coma,mydriasis or not were analysised.Result:The comparison between operative patients and medical treatment patients :the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them had statistical significance. The comparison between operation patients and medical treatment patients in the below 60 years group: the mortality was lower, overall prognosis was better(P<0.05),both had statistical significance; the disability rate of survivors was lower(P>0.05),but had no statistical significance. The comparison between operation patients and medical treatment patients in the above 60 years group: the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them had statistical significance. In the operative group, the comparison between patients below 55 years and above 55 years: the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them had statistical significance. The comparison between patients whose infarction volume on CT smaller than 370cm~3 and patients whose infarction volume on CT exceed 370cm~3: the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them have statistical significance. The comparison between patients whose displace of mean line on CT smaller than 10mm and patients whose displace of mean line on CT exceed 10mm: the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them had statistical significance. The comparison between patients whose NIHSS score before operation smaller than 19 and patients whose NIHSS score before operation exceed 19: the mortality was lower, overall prognosis was better and the disability rate of survivors was lower(P<0.05),all of them had statistical significance. The interval between operation and stroke had no definite correlation with patients' mortality and overall prognosis(P>0.05). In the cardiogenic embolism group , the interval between operation and stroke was longer in the good prognosis patients(P<0.05). The mortality in the intracal decompressive was higher(P<0.05),it had statistical significance. The prognosis and linguistic function between left and right hemisphere infarction had no statistical difference(P>0.05).The patients who had coma and mydriasis before operation had higher mortality(P<0.05).Conclusion:The surgical therapy contrast medical treatment in the massive hemispheric infarction patients:the surgical therapy decreased mortality , improved the quality of life, especially in the younger patients. The patients below 55 years,the infarction volume on CT before operation smaller than 370cm~3, the the displace of mean line on CT before operation smaller than 10mm,the NIHSS score before operation smaller than 19 had better prognosis. The interval between operation and stroke had no apparente influence on prognosis,but it was better to do the operation earlier before cerebral hernia. The patients whose pathogenesy were cardiogenic embolic had worse prognosis.