Long-term outcome after decompressive hemicraniectomy for malignant middle cerebral artery infarction

Abstract

Background Although decompressive hemicraniectomy (DHC) is a lifesaving treatment strategy for patients with malignant middle cerebral artery infarction (mMCAi), only one in four patients achieves low to moderate post-stroke disability according to previous studies. However, the short follow-up periods in prior studies could have overestimated the poor clinical prognosis. This study therefore examined the long-term outcome after DHC for mMCAi. Methods We retrospectively included all patients who had undergone DHC after mMCAi at the University Hospital Graz between 2006 and 2019. Demographics, clinical data and complications were collected from electronic clinical patient records. To investigate long-term prognosis, all patients were followed up to 14 years after stroke including quality of life (QOL) assessment. Post-stroke disability was rated according to the modified Rankin Scale (mRS). Results Of 47 patients that had undergone DHC for mMCAi, follow-up data were available in 40 patients (mean age: 48 years; 40% female). Six months after the mMCAi, 14 patients had died (35%) and nine (23%) had a low to moderate post-stroke disability (mRS 0–3). Of 26 stroke survivors, half (50%) showed further mRS improvement (≥ 1 point) during the long-term follow-up period (mean follow-up time: 8 years). At last follow-up, 17 patients had achieved an mRS score of ≤ 3 (65% versus 35% after 6 months; p = 0.008) and 55% had no signs of depression and anxiety, and 50% no signs of pain or discomfort in QOL assessment. Conclusion This study shows substantial long-term improvement of functional disability and reasonable QOL in mMCAi patients after DHC.

Long-term quality of life after decompressive craniectomy

“…Then, motor impairments may influence this result. Several studies on stroke have observed that the physical summary is altered ( 6 , 9 , 10 , 12 , 22 – 24 ). We also determined lower scores in physical subscales compared with the general population, but no patient with MCA infarction was enrolled in this study.…”

“…It is important to consider the time from DC to the completion of the survey since several studies report short-term QoL ( 7 , 10 , 27 ). Neurological recovery after a life-threatening event is faster initially but may last for more than 1 year, so early evaluation may not represent health for the rest of their lives ( 9 ). We only included patients with a minimum follow-up of 1 year; the median time elapsed from the event to the outcome assessment was almost 4 years (47 months; IQR 21.5–67.5).…”

“…We only included patients with a minimum follow-up of 1 year; the median time elapsed from the event to the outcome assessment was almost 4 years (47 months; IQR 21.5–67.5). QoL was considered poor at a 1-year follow-up after poor-grade aneurysmal subarachnoid hemorrhage ( 8 ) but reasonable in MCA infarction patients after a mean follow-up of 8 years ( 9 ) or even good after TBI up to 10 years after injury ( 14 ). Then, it is essential to consider long-term outcomes in decision-making.…”

“…It is interesting to know how this procedure influences QoL, especially to analyze health-related QoL (HRQoL), which assesses the physical, psychological, social, and functional situations. Different scales, such as the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) ( 6 , 7 ), the EuroQoL ( 8 , 9 ), the “Sickness Impact Profile” (SIP) ( 10 ), different versions of the “Stroke Impact Scale” (SIS) ( 11 , 12 ), or the “Quality of Life after Brain Injury” scale (QOLIBRI) ( 13 , 14 ), have been used for this purpose.…”