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Weighing the options after life-altering stroke
Date:3/12/2009

omy. In that procedure, doctors remove a piece of the skull temporarily, limiting further damage by giving the brain room to swell. The portion of the skull that is removed is put back in place a few months later.

Typically the decision whether or not to go ahead with the surgery is made by families grappling with the catastrophic effects of severe stroke on their loved one. In the face of great uncertainty and under great duress and time pressures, families have to make the decision.

"There is no reliable early predictor of how most people will do after a stroke," said Kelly, an instructor and fellow in the Department of Neurology.

"Some people have a small stroke, with few effects, and we can predict that outcome fairly well. Others have strokes that are immediately catastrophic. But the vast majority of patients are in the middle, and we have a hard time predicting what the outcome will be. There is a lot we don't know about how the brain responds to injury, and how it recovers," Kelly said.

Kelly and Holloway studied data from three studies in Europe that looked at the outcomes of 93 people after stroke. The studies demonstrated that patients who didn't have the surgery were about three times more likely to die within a year than patients who did have the surgery, though many of the surgical patients were left with considerable disability.

Using a technique called decision analysis, Kelly and Holloway re-evaluated the outcomes of these trials to incorporate quality-of-life ratings for surviving patients. The authors found that even in the face of significant stroke-related disability, as a whole, patients who had undergone the surgical procedure had an improvement in their quality of life. The physicians then used a related method called sensitivity analysis to determine situations in which surgery might not be the preferred treatment. Only under circumstances where patients valued the outcome after stroke extremely p
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Contact: Tom Rickey
tom_rickey@urmc.rochester.edu
585-275-7954
University of Rochester Medical Center
Source:Eurekalert

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