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

Middelaar, Tessa van; Nederkoorn, Paul J.; Worp, H. Bart van der; Stam, Jan; Richard, Edo

doi:10.1111/ijs.12329

Cited by 39 publications

(32 citation statements)

References 39 publications

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“…The majority of patients who enter these new states of disability and impairment, however, can find new meaning and happiness during this period of adjustment. 74 Health-Related Quality of Life Stroke patients and families often report lower HRQOL than nonstroke patients, and HRQOL is correlated with the severity of the stroke. 1,75 Particular attention is needed for young children, older patients, and those with impaired communication because they are at highest risk for inadequate assessment and symptom management.…”

Section: Adverse Eventsmentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

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AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

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Section: Adverse Eventsmentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

View full text Add to dashboard Cite

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“…[12][13][14][15][16] Our own stratification was informed by multiple independent studies of physicians, nurses, and the general public in which 6%-38% of respondents considered mRS 4 a quality of life worth living. 12,13,15,16 Nonetheless, retrospective studies have shown that most MCI patients who have undergone DC have a reasonable quality of life and are satisfied with their treatment, even those with an mRS of 4, [33][34][35] creating an inherent difficulty in defining acceptable outcomes. Therefore, our findings should not be applied rigidly, but rather serve as a framework for clinical decision-making based upon individual patient and family goals of care.…”

Section: Discussionmentioning

confidence: 99%

Early decompressive craniectomy for malignant cerebral infarction

2016

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Background: Decompressive craniectomy (DC) is an aggressive life-saving surgical intervention for patients with malignant cerebral infarction (MCI). However, DC remains inconsistently and infrequently utilized, primarily due to enduring concern that increased survival occurs only at the cost of poor functional outcome. Our aim was to clarify the role of DC performed within 48 hours (early DC) for patients with MCI, including patients aged .60 years. Methods: We performed a meta-analysis of all available randomized controlled trials comparing early DC to best medical care for MCI. Studies were identified through literature searches of electronic databases including PubMed, EMBASE, and Scopus. We employed a Mantel-Haenszel fixed effects model to assess treatment effect on dichotomized modified Rankin Scale (mRS) outcomes at 12 months. Results: A total of 289 patients from 6 randomized controlled trials comparing early DC to best medical care were included. Early DC resulted in an increased rate of excellent outcomes, defined as mRS #2 (relative risk [RR] 2.81, 95% confidence interval [CI] 1.01-7.82, p 5 0.047), and favorable outcomes, defined as mRS #3 (RR 2.06, 95% CI 1.25-3.40, p 5 0.005). Early DC also increased the rate of survival with unfavorable outcomes, defined as mRS 4-5 (RR 3.03, 95% CI 1.98-4.65, p , 0.001). Conclusions: Early DC increases the rate of excellent outcomes, i.e., functional independence, in addition to favorable and unfavorable outcomes; however, these findings must be interpreted within the context of patients' goals of care. We have developed a clinical decision algorithm that incorporates goals of care, which may guide consideration of early DC for MCI in clinical practice. Neurol Clin Pract 2016;6:433-443 M alignant cerebral infarction (MCI) refers to large-volume ischemic strokes involving the middle cerebral artery territory, which are complicated by lifethreatening cerebral edema. 1 Managed medically, MCI carries a mortality rate of 80%. 1,2 Decompressive craniectomy (DC), the surgical removal of a portion Editorial, page 381

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“…A systematic review suggested that the quality of life (QoL) at long-term follow-up is only moderately decreased when compared with the general population and that the vast majority of patients are satisfied with the treatment received [97]. Interestingly, only one third of neurologists estimated that the majority of patients with MMI had an acceptable QoL based on Fig.…”

Section: How About Quality Of Life?mentioning

confidence: 99%

“…Please note that this flowchart is only illustrative and often times these steps happen simultaneously as any delay in appropriate treatment may impact outcomes the severity of expected deficits [98]. This may suggest that patients' resilience and ability to adapt to a significant deficit are greater than physician expectations and that other factors than mental and physical health like social status and support network may play significant roles [97]. In addition, recent evidence suggests that QoL and functionality in activities of daily living continue to improve beyond the initial year survived [99].…”

Section: How About Quality Of Life?mentioning

confidence: 99%

Malignant MCA Stroke: an Update on Surgical Decompression and Future Directions

Maciel

Sheth

2015

Curr Atheroscler Rep

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Despite a decline over the past decade in overall stroke mortality, hemispheric strokes retain a strikingly high mortality due to their potential for malignant edema and herniation. The pathogenesis of ischemic cerebral edema is steered by disruption of ionic homeostasis in the neurogliovascular unit. Significant effort has been made to identify potential medical therapies targeting edema formation with promising results. To date, decompressive craniectomy remains the therapy with the most robust impact on mortality. Historically, patient selection for surgical treatment of malignant supratentorial strokes has focused on a strict age cutoff and hemispheric dominance. Recent evidence supports a significant mortality benefit in elderly population, although the impact in morbidity is modest. Careful patient selection for surgical treatment in conjunction with comprehensive neurocritical care and inclusion of family in the educated decision making process remain the mainstay of care for such shattering disease.

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

Abstract: Most patients treated with surgical decompression for space-occupying infarction have a reasonable quality of life at long-term follow-up and are satisfied with the treatment received. Severe depressive symptoms are uncommon.

Cited by 39 publications

References 39 publications

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Early decompressive craniectomy for malignant cerebral infarction

Malignant MCA Stroke: an Update on Surgical Decompression and Future Directions

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