title: Long-term outcome and quality of life after craniectomy in speech-dominant swollen middle cerebral artery infarction.
abstract: BACKGROUND
  Decompressive craniectomy in malignant middle cerebral artery infarction (MMCAI) reduces mortality. Whether speech-dominant side infarction results in less favorable outcome is unclear. This study compared functional outcome, quality of life, and mental health among patients with speech-dominant and non-dominant side infarction.
  
  
  METHODS
  All patients undergoing decompressive craniectomy for MMCAI were included. Demographics, side of infarction, and speech-dominant hemisphere were recorded. Outcome at follow-up was assessed by global functioning (modified Rankin Scale score), neurological impairment (National Institutes of Health Stroke Scale score), dependency (Barthel Index), anxiety and depression (Hospital Anxiety and Depression scale), and quality of life (Short Form-36).
  
  
  RESULTS
  Twenty-nine out of 45 patients (mean age ± SD, 48.1 ± 11.6 years; 58 % male) were alive at follow-up, and 26 were eligible for analysis [follow-up, median (interquartile range): 66 months (32-93)]. The speech-dominant hemisphere was affected in 13 patients. Outcome for patients with speech-dominant and non-dominant side MMCAI was similar regarding neurological impairment (National Institutes of Health Stroke Scale score, mean ± SD: 10.3 ± 7.0 vs. 8.9 ± 2.7, respectively; p = 0.51), global functioning [modified Rankin Scale score, median (IQR): 3.0 [2-4] vs. 4.0 [3-4]; p = 0.34], dependence (Barthel Index, mean ± SD: 16.2 ± 5.0 vs. 13.1 ± 4.8; p = 0.12), and anxiety and depression (Hospital Anxiety and Depression scale, mean ± SD: anxiety, 5.0 ± 4.5 vs. 7.3 ± 5.8; p = 0.30; depression, 5.0 ± 5.2 vs. 5.9 ± 3.9; p = 0.62). The mean quality of life scores (Short Form-36) were not significantly different between the groups.
  
  
  CONCLUSIONS
  There was no statistical or clinical difference in functional outcome and quality of life in patients with speech-dominant compared to non-dominant side infarction. The side affected should not influence suitability for decompressive craniectomy.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway, jarle.sundseth@rikshospitalet.no.
authors.forename: Jarle
authors.initials: J
authors.lastname: Sundseth
authors.forename: Antje
authors.initials: A
authors.lastname: Sundseth
authors.forename: Bente
authors.initials: B
authors.lastname: Thommessen
authors.forename: Lars G
authors.initials: LG
authors.lastname: Johnsen
authors.forename: Marianne
authors.initials: M
authors.lastname: Altmann
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sorteberg
authors.forename: Karl-Fredrik
authors.initials: KF
authors.lastname: Lindegaard
authors.forename: Jon
authors.initials: J
authors.lastname: Berg-Johnsen
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D013060:Speech / Q000502:physiology*; D055815:Young Adult