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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Functional impairment, disability and quality of life outcome after hemicraniectomy in malignant middle cerebral artery infarction

Funktionelle Beeinträchtigung, Behinderung und Lebensqualität nach Hemikraniektomie bei malignem Mediainfarkt

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  • corresponding author Josef Michael Lang - Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main
  • C. Foerch - Neurologische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main
  • J. Krause - Neurologische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main
  • A. Raabe - Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main
  • K. R. Kessler - Neurologische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main
  • V. Seifert - Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Frankfurt, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.14.06

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0139.shtml

Published: April 23, 2004

© 2004 Lang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

Decompressive hemicraniectomy (DHC) as a treatment of space-occupying middle cerebral artery infarction is still a controversial issue. Previous studies agreed on a reduction of mortality, but functional outcome was highly variable. We sought to determinine functional impairment, disability and health-related quality of life (HRQL) outcome in long-term survivors and tried to identify prognostic variables.

Methods

We included 36 consecutive patients (mean age 58.8±12.7 years, 16 women) who underwent DHC due to malignant MCA infarction (right/left side 29/7, mean time to surgery 38±20 hours). Survival rate was determined at six months. 13.7±6.7 months following stroke, a cross sectional investigation was performed to assess functional impairment, disability and health-related qualitity of life.

Results

Survival rates were 78% at six months and 64% at the time of the follow-up investigation, one patient was lost to follow-up. Sixteen out of 22 long-term survivors lived at home. Median Barthel Index (BI) was 45 (25th/75th percentile, 19/71) and BI correlated negatively with patient age (r= -0.58, p= 0.005). Three patients reached a BI greater or equal than 90. Higher age, more severe neurological deficit at admission and longer duration of intensive care treatment and mechanical ventilation were significantly associated with higher disability (BI less than 50). Health-related quality of life was considerably impaired in the subscales mobility, household management and body care.

Conclusions

DHC improves survival in malignant MCA infarction when compared with earlier reports of conservative treatment alone. Functional outcome and health-related quality of life remain markedly impaired, especially among elderly patients and those with a severe neurological deficit at admission.