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Quality of Life Following Hemicraniectomy for Malignant MCA Territory Infarction

Published online by Cambridge University Press:  02 December 2014


Alexander G. Weil
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
Ralph Rahme
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
Robert Moumdjian
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
Alain Bouthillier
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
Michel W. Bojanowski
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada

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).

Conclusion:

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.


Résumé:

Résumé: Objectif:

Il a été bien démontré que l’hémicraniectomie décompressive (HD) diminue la mortalité chez les patients qui ont subi un infarctus malin dans le territoire de l’artère cérébrale moyenne (ACM). Plusieurs des patients qui survivent présentent une invalidité de modérée à sévère. Il existe une controverse à savoir ce qui devrait être considéré comme étant un bon résultat. Nous avons évalué la qualité de vie (QV) de patients après une HD effectuée suite à un infarctus malin dans le territoire de l’ACM dans notre milieu.

Méthode:

Nous avons évalué le résultat chez tous les patients ayant subi une HD suite à un infarctus malin dans le territoire de l’ACM entre 2001 et 2009 au moyen d’une analyse rétrospective de dossier et un suivi téléphonique chez les survivants. Nous avons déterminé le résultat fonctionnel au moyen de la Glasgow outcome scale, de la modified Rankin scale (mRS) et du Bartel index (BI) et la QV au moyen de la Stroke Impact Scale.

Résultats:

Nous avons identifié 14 patients, 6 hommes et 8 femmes, dont l’âge moyen était de 44 ans (écart de 27 à 57 ans). Tous les patients avaient un niveau de conscience diminué avant la chirurgie. Cinq avaient subi un accident vasculaire cérébral de l’hémisphère dominant. L’intervalle médian entre l’événement et la chirurgie était de 45 heures (écart de 1 à 96 heures). Deux patients sont décédés et 1 patient n’a pas pu être rejoint pour le suivi. Parmi les 11 survivants, l’issue fonctionnelle a été favorable chez 7 patients (63,6%), soit un score mRS < 4. Aucun patient n’était dans un état végétatif persistant. La majorité des patients dont nous avons fait l’entrevue et des soignants (7 de 8), incluant ceux qui avaient subi unAVC à l’hémisphère dominant, étaient satisfaits après un suivi médian de 18 mois (écart de 6 à 43 mois) malgré une QV altérée, particulièrement dans les domaines physiques.

Conclusion:

La plupart des patients rapportent une QV satisfaisante malgré une invalidité significative, même ceux qui présentent une invalidité de modérée à sévère et un AVC de l’hémisphère dominant. Un infarctus malin de l’ACM de l’hémisphère dominant ne devrait pas être considéré comme une contre-indication à l’HD.


Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

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