title: Quality of life following hemicraniectomy for malignant MCA territory infarction.
abstract: OBJECTIVE
  Decompressive hemicraniectomy (DH) has been shown to reduce mortality in patients with malignant middle cerebral artery (MCA) territory infarction. However, many patients survive with moderate-to-severe disability and controversy exists as to whether this should be considered good outcome. To answer this question, we assessed the quality of life (QoL) of patients after DH for malignant MCA territory infarction in our milieu.
  
  
  METHODS
  The outcome of all patients undergoing DH for malignant MCAterritory infarction between 2001 and 2009 was assessed using retrospective chart analysis and telephone follow-up in survivors. Functional outcome was determined using Glasgow outcome scale, modifed Rankin scale (mRS), and Barthel index (BI). The stroke impact scale was used to assess QoL.
  
  
  RESULTS
  There were 14 patients, 6 men and 8 women, with a mean age of 44 years (range 27-57). All patients had reduced level of consciousness preoperatively. Five had dominant-hemisphere stroke. Median time to surgery was 45 hours (range 1- 96). Two patients died and one was lost to follow-up. Of 11 survivors, 7 (63.6%) had a favorable functional outcome (mRS<4). No patient was in persistent vegetative state. Despite impaired QoL, particularly in physical domains, the majority of interviewed patients and caregivers (7 of 8), including those with dominant-hemisphere stroke, were satisfied after a median follow-up of 18 months (range 6-43).
  
  
  CONCLUSIONS
  Most patients report satisfactory QoL despite significant disability even in the face of moderate-to-severe disability and dominant-hemsiphere stroke. Dominant-hemisphere malignant MCA territory infarction should not be considered a contraindication to DH.
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Weil
authors.forename: Ralph
authors.initials: R
authors.lastname: Rahme
authors.forename: Robert
authors.initials: R
authors.lastname: Moumdjian
authors.forename: Alain
authors.initials: A
authors.lastname: Bouthillier
authors.forename: Michel W
authors.initials: MW
authors.lastname: Bojanowski
mesh_terms: D000328:Adult; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome