Brain Neurorehabil.  2014 Mar;7(1):48-53. 10.12786/bn.2014.7.1.48.

Functional Outcomes of Patients with Severe MCA Infarction after Decompressive Craniectomy

• Lee KW
• Kim SB
• Lee JH
• Kim MA
• Ri JW
• Park JG

• KMID: 1914559
• DOI: http://doi.org/10.12786/bn.2014.7.1.48

Abstract

OBJECTIVE
To compare the functional outcomes between surgical treatment and conservative medical treatment for severe middle cerebral artery (MCA) infarction. METHOD: This is comparative analysis of prospectively documented data with 25 patients have malignant MCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such as decompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservative medical treatment. We defined MCA infarction as "severe" when it concerned both the deep and superficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75 on 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 baseline and 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 were 4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baseline functional status between two groups was not significantly different. Each group showed functional improvement 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 and TCT 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 patients with severe MCA infarction more than conservative medical treatment alone.

Keyword

cerebrovascular disease; decompressive craniectomy; functional outcome; stroke

MeSH Terms

Arm
Decompressive Craniectomy*
Female
Humans
Infarction
Infarction, Middle Cerebral Artery*
Leg
Middle Cerebral Artery
Prospective Studies
Stroke

Figure

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  Fig. 1 Flow chart of patient group assignment and treatment.

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  Fig. 2 Change of Trunk Control Test in both groups. Group A: Patients with decompressive craniectomy. Group B: Patients without decompressive craniectomy. *p<0.05.

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  Fig. 3 Change of Motricity Index leg score in both groups. Group A: Patients with decompressive craniectomy. Group B: Patients without decompressive craniectomy. *p<0.05.

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