ObjectiveTo evaluate the surgical efficacy of and factors associated with decompressive craniectomy in patients with an internal carotid artery (ICA) territory infarction.MethodsSeventeen patients (8 men and 9 women, average age 61.53 years, range 53-77 years) were treated by decompressive craniectomy for an ICA territory infarction at our institute. We retrospectively reviewed medical records, radiological findings, and National Institutes of Health Stroke Scale (NIHSS) at presentation and before surgery. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS).ResultsOf the 17 patients, 15 (88.24%) achieved a poor outcome (Group A, GOS 1-3) and 2 (11.76%) a good outcome (Group B, GOS 4-5). The mortality rate at one month after surgery was 52.9%. Average preoperative NIHSS was 27.6±10.88% in group A and 10±4.24% in group B. Mean cerebral infarction fraction at the septum pellucidum level before surgery in group A and B were 33.67% and 23.72%, respectively. Mean preoperative NIHSS (p=0.019) and cerebral infarction fraction at the septum pellucidum level (p=0.017) were found to be significantly associated with a better outcome. However, no preexisting prognostic factor was found to be of statistical significance.ConclusionThe rate of mortality after ICA territory infarction treatment is relatively high, despite positive evidence for surgical decompression, and most survivors experience severe disabilities. Our findings caution that careful consideration of prognostic factors is required when considering surgical treatment.

A 42-year-old man had an unstable Jefferson type IV atlas fracture with unilateral vertebral artery occlusion after a diving accident. We performed C1-ring reconstruction with a crosslink rod and C2 fixation to directly reduce the fracture fissure. Within 6 h, cerebellar hemisphere infarction developed. After decompressive craniectomy, duroplasty, and release of the vertebral artery occlusion caused by the transfixing rod, a postoperative computed tomography angiogram showed that blood flow in the right vertebral artery improved. We suggest cautiously inserting screws into the fractured C1 lateral mass and gently tightening the crosslink rod to prevent distal migration of a thrombus.

Objective: The purpose was to comparatively assess cervical sagittal alignment and health-related quality of life (HRQOL) outcomes, between patients who underwent cervical expansive laminoplasty (EL) and those who underwent cervical laminectomy with fusion (LF) for cervical ossification of the posterior longitudinal ligament (OPLL) in more than three levels. Methods: We retrospectively evaluated consecutive patients with cervical OPLL undergoing posterior cervical decompression from 2013-2015. We analyzed radiological measurements (C2-7 sagittal vertical axis [C2-7 SVA], C0-2 angle, C2-7 lordotic angle, T1 slope, and range of motion [ROM]) and clinical outcomes (visual analog scale, neck disability index, Short Form-36, and Japanese Orthopaedic Association scores), preoperatively and at the last follow-up. Results: There were 84 patients (63 men; 21 women). Mean follow-up period was 27.7 months (range: 24-48.8). Compared with preoperative C2-7 SVA, postoperative C2-7 SVA was significantly increased in patients in the LF (13.46 mm) and EL (2.11 mm) groups. Losses of the cervical lordotic angle and ROM were larger in cervical LF patients than in cervical EL patients. The change in the C2-7 SVA was negatively correlated with the change in the C2-7 lordotic angle and positively correlated with changes in the T1 slope and C0-2 angle. Improvements in health-related quality of life were similar between the two groups, except for patient-reported neck pain. Conclusion: Cervical EL and LF were effective surgical techniques to improve the patient-reported outcomes and HRQOL of patients with OPLL in more than three levels. Cervical EL can preserve sagittal alignment and improve clinical results and neck pain, more than cervical LF. Cervical sagittal imbalance after posterior decompression was related to axial neck pain.