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Tham khảo tài liệu 'acute ischemic stroke part 11', khoa học tự nhiên, công nghệ sinh học phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Surgical Treatment of Patients with Ischemic Stroke Decompressive Craniectomy 169 Fig. 2. CT scan on day one demonstrating evolving R MCA infarction with mass effect and compression of the ventricular system. Clinical examination revealed right midriazis Proposed as a life-saving procedure increasing experimental and clinical evidence indicates that an early decompressive craniectomy can limit the extension of the infarcted area. From a mechanical perspective hemicraniectomy provides an immediate opening in the otherwise closed cranial vault. Therefore compression of normal tissue is prevented or limited. The additional space created allows the tissue to expand through the bone defect away from midline structures so that CT-demonstrated changes normally observed when surgery is not performed like midline shift decreased ventricular size and herniation are minimized or completely resolved postoperatively. 37 41 61 As the cranial vault has essentially been expanded during surgery there is an immediate decrease of ICP. The initial ICP values of 25 to 60 mm Hg decreased by 15 once the bone flap was removed and by 70 once the dura was opened resulting in the normalization of the ICP after surgery. 32 Similar findings were demonstrated when performed a bilateral craniectomy. 78 80 In 2 patients with ischemic CVA whose initial ICP values were 54.8 mm Hg and 20 mm Hg respectively removal of the bone flap caused a decrease in ICP to 35.5 mm Hg and 10 mm Hg and opening of the dura caused a reduction to 4.4 mm Hg and 3 mm Hg respectively. In the immediate postoperative period the ICP values were recorded as 4.4 mm Hg and 10.2 mm Hg. A decrease in ICP allows for an increase in cerebral perfusion pressure aiding blood flow to the ischemic area optimizing circulation to the damaged area through collateral vessels. Because hemicraniectomy alone may improve blood flow in the ischemic area surgical resection of the infracted tissue should not be conducted in these patients. .
