title: Hemicraniectomy for malignant middle cerebral artery infarction: retrospective consent to decompressive surgery depends on functional long-term outcome.
abstract: BACKGROUND
  Decompressive surgery for malignant middle cerebral artery infarction increases the number of surviving patients; this, however, leaves some patients severely disabled. This study analyzed the patients' retrospective consent to hemicraniectomy in light of the experienced functional outcome 12 months after hospital stay.
  
  
  METHODS
  This retrospective study included all patients who underwent decompressive hemicraniectomy for malignant middle cerebral artery infarction in the Department of Neurology, University of Erlangen, Germany, from January 2006 until March 2009. Data on mortality and functional outcome (measured by the modified Rankin Scale; mRS) 6 and 12 months after treatment were correlated with retrospective consent to hemicraniectomy as well as with a quality of life instrument (EuroQol). Data were obtained by structured telephone interviews with the patients themselves or their closest relatives.
  
  
  RESULTS
  In the study period 28 patients received decompressive surgery. Retrospective consent to hemicraniectomy was 82.1%. Five patients, or their closest relatives, would not agree to hemicraniectomy again, given their functional outcome after 1 year. Two out of two patients who experienced an mRS of 5 would not have consented. Low quality of life was most often declared in this subgroup.
  
  
  CONCLUSIONS
  Retrospective consent to hemicraniectomy for treatment of malignant MCA infarction depends on functional long-term outcome. We need to identify those patients who would survive the malignant MCA infarction due to decompressive surgery but only reach a severely reduced functional status.
authors.affiliation: Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. ines-christine.kiphuth@uk-erlangen.de
authors.forename: Ines C
authors.initials: IC
authors.lastname: Kiphuth
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichy
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D056424:Decompressive Craniectomy / Q000379:methods / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult