中大脳動脈領域広範囲梗塞に対する減圧開頭術の試み

Decompressive Craniectomy for Massive Infarction of Middle Cerebral Artery Territory

1．はじめに

　中大脳動脈領域の広範囲脳梗塞は予後不良の疾患で，著しい脳浮腫により5日以内に78％が脳ヘルニアを来し^2），mortalityは約80％と報告されている^1-5），このように致死率の高い疾患であるにもかかわらず，その治療法に一定の見解は得られていない．最近，広範囲脳梗塞に対し減圧開頭術を行い，良好な成績が報告されている^6-10）．われわれも1997年より，積極的に減圧開頭術を行ってきた．今回その有用性を検討した．

There is continuing controversy about the benefits of decompressive craniectomy for the treatment of massive infarction of middle cerebral artery (MCA) territory. Under conservative therapy, the mortality rate for this stroke is reported to be up to 80%. So the authors have actively carried Out decompressive cra-niectomy since 1997, and have compared the outcome with patients who were admitted before 1997 and, consequently treated with conservative therapy. Fifteen consecutive victims of massive infarction of MCA territory were studied. Seven patients (male : 1, female : 6, mean age : 79.8 years) were treated with con-servative therapy, and 8 patients (male : 3, female : 5, mean age : 71.8 years) were treated with decom-pressive craniectomy. There were no significant differences in age and consciousness level distribution be-tween the two groups. Mortality rate in the conservative therapy group was 85.7% against 12.5% in the surgery group (p ＜0.05) . Functional performance, which was evaluated by activity in daily life (ADL), was also better in the surgery group e.g. 3 patients in ADL 3, and 3 in ADL 4 (1 patient died from a non-neurological cause). Even among the patients with speech-dominant hemispheric stroke, all except one were able to communicate in some way and understand language. Even though patients in this study were elderly, decompressive cranietomy reduced mortality and improved functional performance, so it seems that this surgery should be aggressively considered for massive infarction of MCA territory.