Long-Term Outcome After Suboccipital Decompressive Craniectomy for Malignant Cerebellar Infarction
- 1 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 40 (9), 3045-3050
- https://doi.org/10.1161/strokeaha.109.550871
Abstract
Background and Purpose— Suboccipital decompressive craniectomy (SDC) is a life-saving intervention for patients with malignant cerebellar infarction. However, long-term outcome has not been systematically analyzed. Methods— In this monocentric retrospective study we analyzed mortality, long-term functional outcome, and quality of life of all consecutive patients that were treated by SDC for malignant cerebellar infarction in our institution between 1995 and 2006. Results— A total of 57 patients were identified. All of them were treated by bilateral SDC. An external ventricular drainage was inserted in 82%, necrotic tissue was evacuated in 56% of patients. There were no fatal procedural complications. Five patients were lost for follow-up. In the remaining 52 patients, the mean follow-up interval was 4.7 years (1 to 11 years). Within the first 6 months after surgery 16 of 57 patients (28%) had died. At follow-up, 21 of 52 patients (40%) had died and 4 patients (8%) lived with major disability (mRS 4 or 5). Twenty-one patients (40%) lived functionally independent (mRS 0 to 2). The presence of additional brain stem infarction was associated with poor outcome (mRS ≥4; hazard ratio: 9.1; P =0.001). Quality of life in survivors was moderately lower than in healthy controls. Conclusions— SDC is a safe procedure in patients with malignant cerebellar infarction. Infarct- but not procedure-related early mortality is substantial. Long-term outcome in survivors is acceptable, particularly in the absence of brain stem infarction.This publication has 20 references indexed in Scilit:
- Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarctionActa Neurologica Scandinavica, 2008
- Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY)Stroke, 2007
- Sequential-Design, Multicenter, Randomized, Controlled Trial of Early Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction (DECIMAL Trial)Stroke, 2007
- Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar InfarctionNeurosurgery, 2006
- Management of Acute Cerebellar Infarction: One Institution's ExperienceNeurosurgery, 2003
- Decompressive surgery in space-occupying hemispheric infarctionCritical Care Medicine, 1995
- Neurosurgical management of cerebellar haematoma and infarct.Journal of Neurology, Neurosurgery & Psychiatry, 1995
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- Acute obstructive hydrocephalus caused by cerebellar infarction. Treatment AlternativesSurgical Neurology, 1983
- CEREBELLAR STROKES: MORTALITY, SURGICAL INDICATIONS, AND RESULTS OF VENTRICULAR DRAINAGEThe Lancet, 1982