title: Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction.
abstract: OBJECTIVE
  The purpose of this study was to analyse in detail the functional outcome and the neuropsychological deficits in patients with space-occupying infarction of the non-dominant hemisphere one year after surgery.
  
  
  METHODS
  Postoperative complications and retrospective consent to surgery were assessed in a semi-structured interview in 26 patients. Functional outcome was measured with the Barthel-Index (BI) and Rankin-Scale. Neuropsychological tests in 14 patients focused on visuo-spatial and visuo-constructive abilities, attention, spatial span and self-rated mood.
  
  
  RESULTS
  The one-year survival rate was 69 % (18 of 26). The functional outcome was good (BI >/= 90) in 3 patients, fairly good (BI 75-85) in 6, moderate (BI 30-70) in 6, and poor (BI 0-25) in 3 patients. Age was an independent predictor of outcome, patients above 52 years had a BI of 50 or below. Neuropsychological tests (14 of 18) showed profound attention deficits in all patients, and visuo-spatial and visuo-constructive deficits in patients with lower formal education. Retrospectively, 4 of 18 patients would not give consent to surgery again, mostly because of the bad quality of life postoperatively.
  
  
  CONCLUSIONS
  Older patients do not seem to benefit from decompressive hemicraniectomy; more than half of the surviving younger patients have a good outcome and live independently. Attention deficits are prominent in all patients; visuo-spatial and constructive deficits are less pronounced in patients with higher formal education. Retrospective agreement to decompressive hemicraniectomy is high in patients with good functional outcome.
authors.affiliation: Klinik und Poliklinik für Neurologie, Martin-Luther-Universität, Halle-Wittenberg, 06097 Halle/Saale, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Leonhardt
authors.forename: Hans
authors.initials: H
authors.lastname: Wilhelm
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Ehrenfeld
authors.forename: Beate
authors.initials: B
authors.lastname: Schoch
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Rauhut
authors.forename: Andreas
authors.initials: A
authors.lastname: Hufnagel
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003399:Craniotomy / Q000009:adverse effects; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome