Long-term neuropsychological and psychosocial outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions

Abstract

• Malignant middle cerebral artery infarction is a life threatening condition.• The neurosurgical procedure, “decompressive hemicraniectomy” has been shown to be life-saving among patients with this condition.• There is little known about the long-term neuropsychological and psychosocial outcomes following decompressive hemicraniectomy for malignant middle cerebral artery infarction.• This study concludes that neuropsychological impairments are highly probable post-surgery. However, preserved abilities and social support may serve a protective function against depression and an unacceptably poor quality of life.]

Quality of Life after Surgical Decompression for Space-Occupying Middle Cerebral Artery Infarction: Systematic Review

“…Of 615 studies screened and 72 full articles assessed for eligibility, 18 fulfilled our inclusion and quality criteria (Fig. ) . Based on a high risk of selection bias, one study was additionally excluded (the complete validity assessment can be found in the http://onlinelibrary.wiley.com/doi/10.1111/ijs.12329/suppinfo) .…”

“…In the 17 included studies, follow‐up varied from six to 51 months . Of 459 patients who underwent surgical decompression, 134 died during follow‐up, resulting in a pooled mortality of 29·9% (95% CI 25·8–34·4; I 2 = 0·0%) . Thirty‐four patients (10·5%) were lost to follow‐up.…”

“…Eleven studies assessed the presence of depressive symptoms, using a total of five different questionnaires . Eight of these studies categorized their results into no, mild, moderate, or severe depressive symptoms . In a pooled analysis of seven of these studies, 46 of 95 patients (48·5%; 95% CI 38·5–58·6; I 2 = 0·0%) had mild to moderate depressive symptoms.…”

Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarction: The ‘Real World' Beyond Studies

“…The relevance of such deficits and deficiencies and their high likelihood in patients with an MMI has been described in a case series by McKenna et al [21] . The high risk for severe cognitive impairment and depression was evident in a neuropsychological investigation by Schmidt et al [14] , supporting our finding of a clinically relevant depression in more than half of our patients.…”

Decompressive craniectomy, ICP monitoring and secondary necrosectomy as treatment options in patients presenting with malignant ischemic infarctions extending beyond the middle cerebral artery territory

“…50-75%, and these RCTs substantially changed neurosurgical practice. To date, an ever increasing number of publications have documented the role of DC in malignant MCA infarct patients, addressing not only the potential clinical benefits but also complications and important ethical and quality of life concerns [3]. However, there are some remaining clinical questions regarding malignant MCA infarcts that have been insufficiently addressed in the literature.…”