ONE-YEAR OUTCOME AFTER DECOMPRESSIVE SURGERY FOR MASSIVE NONDOMINANT HEMISPHERIC INFARCTION

OBJECTIVE: Massive cerebral infarction is often accompanied by early d eath secondary to transtentorial herniation. We have tested the hypoth esis that decompressive hemicraniectomy for massive nondominant cerebr al infarction is lifesaving in a series of 14 patients presenting with right hemispheric infarction and clinical signs of uncal herniation a nd impending death. We have further analyzed, in prospective follow-up examinations, the levels of physical, psychiatric, and social disabil ities in these patients. METHODS: The methods used included retrospect ive analysis to determine rates of immediate mortality and morbidity a fter surgical intervention. Prospective follow-up data were obtained t o determine the level of recovery in surviving patients after 1 year. Standardized measures of outcome to assess physical, psychiatric, and social recovery included the Barthel Index, Zung Depression Scale, and Reintegration to Normal Living Index. RESULTS: With decompressive hem icraniectomy, we were able to prevent death secondary to transtentoria l herniation in all cases; 11 patients experienced long-term survival after the procedure, and three deaths were related to non-neurological causes. We observed that 8 of the 11 surviving patients were at home, were functioning with minimal to moderate assistance, and had Barthel scores greater than 60. The remaining three patients were severely di sabled. Seven of the 11 survivors were able to walk at 1 year after un dergoing the procedure. Depression and failure to reintegrate socially were experienced by most patients. CONCLUSION: This series confirms t he lifesaving nature of hemicraniectomy in patients deteriorating beca use of cerebral edema after infarction. In patients younger than 50 ye ars, recovery to a state of near-independence is possible.