title: Quality of life after hemicraniectomy for traumatic brain injury in adults. A review of the literature.
abstract: Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.
authors.affiliation: Division of Neurosurgery University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA. danishsh@umdnj.edu
authors.forename: Shabbar F
authors.initials: SF
authors.lastname: Danish
authors.forename: Dean
authors.initials: D
authors.lastname: Barone
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Lega
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D001930:Brain Injuries / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods*