Article
Clinical and computerised volumetric analysis of posterior fossa decompression for space-occupying cerebellar infarction
Klinische und computergestützte volumetrische Analyse der Dekompression der hinteren Schädelgrube bei raumfordernden Kleinhirninfarkten
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Authors
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Eric Goulin Lippi Fernandes
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Sami Ridwan
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland; Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
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Matthias Simon
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: To study outcomes after posterior fossa decompression for cerebellar infarction. The literature contains surprisingly little pertinent data with a 2018 meta-analysis describing only 283 patients pooled from 11 studies.
Methods: We retrospectively identified all patients undergoing posterior fossa decompression and necrosectomy for cerebellar infarction in our department from January 2012 – November 2020. We studied pertinent clinical data and performed computerized volumetric analyses (preoperative/postoperative infarction volume, necrosectomy volume, posterior fossa volume). A favorable functional outcome was defined as mRS 0-3. Standard statistical methods (Fisher exact and chi square test, ANOVA, regression analysis and Student’s t-test) were employed.
Results: We studied 47 patients (68% male, median age: 68 years). 28 cases (60%) presented with hydrocephalus, 19 required temporary CSF drainage and a VP shunt was placed in one case. Bilateral and brainstem involvement was seen in 15 (32%) and 13 (28%) patients, respectively. 40 cases were operated for a GCS of ≤13 or GCS deterioration. 7 (15%) patients had preventive surgery (initial GCS 14-15, no preoperative GCS change). 35 (74%) patients had s GCS of 14-15 at admission. Prior to surgery only 14 (29%) cases had a GCS of 14-15. After surgery the number of patients with a GCS of 14-15 increased to 40 (85%), but only 23 (49%) patients had a mRS 0-3 at discharge. Predictors for a good outcome included a preoperative NIHSS<5 (p=0.018), no brainstem involvement (p=0.022), a >50% necrosectomy (p=0.031) and lesser postoperative infarction volume (p=0.044). The GCS at presentation, before surgery, preventive surgery and preoperative infarct volume did not correlate with functional outcome. A medical history of anticoagulation was a significant predictor of in-hospital mortality (p=0.005).
Conclusion: Posterior fossa decompression for cerebellar infarction is an effective life-saving procedure, but rapid recovery of the GCS after surgery did not necessarily translate into a good functional outcome. Functional outcomes seem primarily determined by the neurological deficit caused by the infarction. Computerized volumetric analysis provided some support for a positive role of aggressive infarct debridement.
