Background:This essay is divided into two parts: 1) a literature study on decompressive hemicraniectomy in patients with massive brain infarction, and 2) a patient-centered study based on the clinical series of Department of neurosurgery, Rikshospitalet (University of Oslo) aiming at recording the patients’ subjective quality of life, mental health and functional outcome after surgery.
Material and method:All 25 patients who received decompressive hemicraniectomy treatment for malignant brain infarction at Rikshospitalet in the period between may 1998 and December 2005, and with a follow up time no less than 12 months, were included. By the time of follow-up, however, 8 patients had died (mortality rate: 32%). All deaths occurred within one month after the brain infarction. Follow-up was thus conducted in 17 survivors having a mean age of 47, 5 years.
The following forms were distributed by mail to all survivors at least 12 months after surgery: SF-36, WHOQOL-Bref, HAD, the Zung self-reporting depression scale (ZSRDS), Barthel’s ADL, modified Rankin Score (mRS), a visual analog scale (VAS) and forms to obtain simple demographic data.
Results and interpretation:12 out of the 17 survivors returned the questionnaires , for a response rate of 71%. As to their subjective perception of quality of life 50% stated that their quality of life was “good” or “very good” whereas 33% valued their quality of life as “poor” or “very poor”. 17% stated that their quality of life was “neither good or bad”.
58% of the responders scored 60 or better (maximum 100) on ADL. The average mRS was 3,0. Female patients reported being to a higher degree tormented by depression, and had in general more loss of motor function than did their male counterparts.
The results showed an inverse correlation between age and functional outcome. Women reported being more physically impaired than did the male respondents. Also, female responders reported more depression, negative feelings and poor quality of life. These findings corroborate results from other clinical series on patients having undergone hemicraniectomy as well as findings from follow-up of stroke patients in general.