title: Long-term health-related quality of life after decompressive hemicraniectomy in stroke patients with life-threatening space-occupying brain edema.
abstract: BACKGROUND
  Although randomized clinical trials have reported significant improvement in mortality and functional outcome as measured with modified Rankin Scale (mRS) or Barthel index (BI) in stroke patients with space-occupying anterior circulation infarctions treated with hemicraniectomy, many clinicians are still concerned about the long-term health-related quality of life (HRQoL).
  
  
  OBJECTIVE
  Assessment of HRQoL after hemicraniectomy to holistically reevaluate clinical outcome.
  
  
  METHODS
  Eleven patients (6 men, 5 women; mean age 48 (SD 5.8) years) were examined at 9-51 months after hemicraniectomy. Test batteries comprised NIH stroke scale, BI, mRS, neuropsychological tests (Visual Object and Space Perception Battery and clock test), and HRQoL-scales (Short Form 36 Health Survey (SF-36), Nottingham Health Profile (NHP), Questions on Life Satisfaction, Hospital Anxiety and Depression Scale and EQ-5D).
  
  
  RESULTS
  Median values for NIHSS, BI and mRS were 11.5, 55 and 3.5. In HRQoL-scales, subscales related to physical mobility and functioning were consistently severely impaired, while subscales related to psychological well-being were impaired to a lesser extent. Mean scores for physical functioning and physical role were 10.5 and 12.5 in the SF-36, and 61.3 and 43.3 for physical mobility and energy in the NHP; emotional role and mental health scored 63.3 and 66.4 (SF-36), scores for emotional reaction and social isolation were 18.9 and 16.0 (NHP), respectively.
  
  
  CONCLUSIONS
  Although, physical components of HRQoL are highly impaired, these stroke patients achieved a satisfying level of psychological well-being which was endorsed by a nearly unanimous retrospective appraisal of life-saving hemicraniectomy.
authors.affiliation: Department of Neurology, University Medicine, Ernst Moritz Arndt University of Greifswald, Ferdinand-Sauerbruch-Str, D-17475 Greifswald, Germany. Bettina.vonSarnowski@uni-greifswald.de
authors.forename: B
authors.initials: B
authors.lastname: von Sarnowski
authors.forename: W
authors.initials: W
authors.lastname: Kleist-Welch Guerra
authors.forename: T
authors.initials: T
authors.lastname: Kohlmann
authors.forename: J
authors.initials: J
authors.lastname: Moock
authors.forename: A V
authors.initials: AV
authors.lastname: Khaw
authors.forename: C
authors.initials: C
authors.lastname: Kessler
authors.forename: U
authors.initials: U
authors.lastname: Schminke
authors.forename: H W S
authors.initials: HW
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001929:Brain Edema / Q000523:psychology* / Q000601:surgery*; D002544:Cerebral Infarction / Q000601:surgery; D003399:Craniotomy; D019299:Decompression, Surgical / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000523:psychology*; D010549:Personal Satisfaction; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012934:Social Isolation; D020521:Stroke / Q000523:psychology* / Q000601:surgery*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome