Long-term Quality of Life After Decompressive Craniectomy in Severe Traumatic Brain Injury and Stroke

PurposeDecompressive craniectomy (DC) can rapidly reduce intracranial pressure and save lives in the acute phase of severe traumatic brain injury (TBI) or stroke, but little is known about the long-term outcome after DC. We evaluated quality of life (QoL) a few years after DC for severe TBI/stroke.MethodsThe following data were collected for stroke/TBI patients hospitalized for neurorehabilitation after DC: 1) at discharge, motor and cognitive sub-scores of the Functional Independence Measure (motor-FIM [score 13-91] and cognitive-FIM [score 5-35]) and 2) more than 4 years after discharge, the QOLIBRI health-related QoL (HR-QoL) score (0-100; <60 representing low or impaired QoL) and the return to work (RTW: 0%, partial, 100%)ResultsWe included 88 patients (66 males, median age 38 [interquartile range 26.3-51.0], 65 with TBI/23 stroke); 46 responded to the HR-QoL questionnaire. Responders and non-responders had similar characteristics (age, sex, functional levels upon discharge). Median motor-FIM and cognitive-FIM scores were 85/91 and 27/35, with no significant difference between TBI and stroke patients. Long-term QoL was borderline low for TBI patients and within normal values for stroke patients (score 58.0[42.0-69.0] vs. 67.0[54.0-81.5], p=0.052). RTW was comparable between the groups (62% full time).ConclusionWe already knew that DC can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable.