Abstract
Objective To systematically evaluate the efficacy and safety of decompressive craniectomy and conservative treatment within 48 h of onset in malignant middle cerebral artery infarction. Methods Cochrane Library, Pubmed, Embase, CNKI, Chinese Biomedical Database, VIP information database, Wanfang database were searched, and the retrieval time was from the library being built to April 31, 2015. Review Mannager 5.2 statistical analysis software was used to evaluate the treatment efficacy of decompressive craniectomy and conservative therapy, amd modified Rankin scale (mRS) scores were considered as the efficacy evaluation criteria. Results A total of six randomized controlled trial studies and two prospective studies were selected, including 201 patients from the decompressive craniectomy group and 197 patients from the conservative treatment group. The mortality of the two groups after 12 months of treatment was significantly different (mRS scores=6,P= 0.000, OR=0.18, 95%CI: 0.12-0.29). Moderate or severe disability rate after 6 months of treatment was significantly different (mRS scores=4-5,P=0.000, OR=3.36, 95% CI: 1.95-5.78), and that after 12 months of treatment was also significantly different (P=0.000, OR=4.62, 95% CI: 2.64-8.07). The number of patients enjoyed good life quality (mRS scores≤3) 6 and 12 months after treatment between the two groups was statistically significant (P=0.010, OR=2.69, 95%CI: 1.21-5.96;P=0.020, OR=2.07, 95%CI: 1.11-3.87); mortality rate (mRS scores=6) and disability rate (mRS scores=3-5) of patients aged more than 60 years between the two groups were significantly different (P=0.000, OR=0.20, 95% CI: 0.10-0.42;P=0.000, OR=4.94, 95% CI: 2.35-10.35). Conclusion Regardless of age greater or less than 60 years old, decompressive craniectomy can significantly reduce the mortality of patients with malignant middle cerebral artery infarction within 48 hours as compared with conservative treatment, but surgery may increase moderate to severe disability. Key words: Decompressive craniectomy; Conservative treatment; Malignant middle cerebral artery infarction; Meta analysis
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