title: Quality of life after surgical decompression for a space-occupying middle cerebral artery infarct: A cohort study.
abstract: BACKGROUND
  In patients with a space-occupying middle cerebral artery (MCA) infarct surgical decompression reduces the risk of death, but increases the chance of survival with severe disability. We assessed quality of life (QoL), symptoms of depression, and caregiver burden at long-term follow-up.
  
  
  METHODS
  Patients treated in two academic centres between 2007 and 2012 were included. Follow-up was at least six months. Patients and caregivers were interviewed separately. QoL was assessed with a visual analogue scale and the 36-item Short-Form health survey (SF-36); depression with the Hospital Anxiety and Depression Scale; and caregiver burden with the Caregiver Strain Index.
  
  
  RESULTS
  Twenty five patients were enrolled, of whom seven had an infarct in the dominant hemisphere. After a median follow-up of 26 months (IQR 11-46) the median SF-36 mental component score was 54.4 (IQR 45-60), indicating a mental QoL comparable to that in the general population. The median SF-36 physical component score was 32.7 (IQR 22-38), indicating a worse physical QoL. Dominance of the hemisphere did not influence QoL. 79 % of patients and 65 % of caregivers would, in retrospect, again choose for surgery. 26 % of patients had signs of depression and 64 % of caregivers were substantially burdened in their daily life.
  
  
  CONCLUSIONS
  Mental QoL after surgical decompression for space-occupying MCA infarct is comparable to that in the general population, whereas physical QoL is worse. Dominance of the hemisphere did not influence QoL. The majority of caregivers experience substantial burden. Most patients and caregivers stand by their decision for hemicraniectomy.
authors: Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. t.vanmiddelaar@amc.uva.nl.
authors: Tessa
authors: T
authors: van Middelaar
authors: Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. e.richard@amc.uva.nl.|Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands. e.richard@amc.uva.nl.
authors: Edo
authors: E
authors: Richard
authors: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands. h.b.vanderworp@umcutrecht.nl.
authors: H Bart
authors: HB
authors: van der Worp
authors: Department of Neurosurgery, Academic Medical Center (AMC) Amsterdam, Amsterdam, The Netherlands. p.vandenmunckhof@amc.uva.nl.
authors: Pepijn
authors: P
authors: van den Munckhof
authors: Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam, The Netherlands. p.t.nieuwkerk@amc.uva.nl.
authors: Pythia T
authors: PT
authors: Nieuwkerk
authors: Department of Neurology, VU University Medical Center (VUmc), Amsterdam, The Netherlands. mc.visser@vumc.nl.
authors: Marieke C
authors: MC
authors: Visser
authors: Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.stam@amc.uva.nl.
authors: Jan
authors: J
authors: Stam
authors: Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. p.j.nederkoorn@amc.uva.nl.
authors: Paul J
authors: PJ
authors: Nederkoorn
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D015331:Cohort Studies; D019299:Decompression, Surgical; D003863:Depression / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life