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Quality of life after decompressive craniectomy for malignant middle cerebral artery infarction
  1. K Vahedi1,
  2. L Benoist1,
  3. A Kurtz1,
  4. J Mateo2,
  5. A Blanquet3,
  6. M Rossignol4,
  7. P Amarenco5,
  8. A Yelnik6,
  9. E Vicaut7,
  10. D Payen8,
  11. M G Bousser9
  1. 1Service de Neurologie, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  2. 2Départment d’Anesthésie-Réanimation, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  3. 3Service de Neurochirurgie, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  4. 4Départment d’Anesthésie-Réanimation, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  5. 5Service de Neurologie, Hôpital Bichat, AP-HP, Paris, France
  6. 6Service de Médecine Physique et de Réadaptation, Hôpital Lariboisière-Fernand Widal, AP-HP, 200 rue du Faubourg, Saint-Denis, 75010 Paris, France
  7. 7Unité de Recherche Clinique, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  8. 8Départment d’Anesthésie-Réanimation, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  9. 9Service de Neurologie, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France
  1. Correspondence to:
 Dr Katayoun Vahedi
 Service de Neurologie, Hôpital Lariboisière, AP-HP, 2 rue A. Paré, 75010 Paris, France; katayoun.vahedilrb.aphp.fr

https://doi.org/10.1136/jnnp.2004.058537

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    Malignant middle cerebral artery (MCA) infarction is a devastating condition leading to early death in nearly 80% of cases due to the rapid rise of intracranial pressure despite maximum medical management of the ischaemic brain oedema.1 Decompressive craniectomy (DC) has been proposed to prevent brain herniation in malignant MCA infarction, but it remains controversial in the absence of randomised controlled trials and because of the fear of a severe residual disability after surgery.1–4 We present herein the results of a quality of life assessment using patient and proxy versions of the Stroke Impact Scale (SIS) in eight patients 12–30 months after craniectomy for malignant MCA infarcts.

    Methods

    Between March 1999 and November 2000, all consecutive patients with malignant MCA infarction were treated by DC and durotomy at Lariboisière Hospital if they were younger than 55 years of age, had a complete MCA infarct as defined by complete MCA territory CT ischaemic changes, and a severe hemiplegia with altered level of consciousness with further neurological deterioration due to brain oedema, and if a close family member gave informed consent. Exclusion criteria were: prestroke moderate to severe disability defined by a modified Rankin scale (mRS)⩾2, haemorrhagic transformation involving more than 50% of the MCA territory, and significant contralateral ischaemia.

    Disability was assessed …

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    Footnotes

    • Competing interests: none declared