Preventive Suboccipital Decompressive Craniectomy for Cerebellar Infarction

Abstract

Background and Purpose-No evidence is available on the benefits of preventive suboccipital decompressive craniectomy (SDC) for patients with cerebellar infarction. The purpose of this matched case-control study was to investigate whether preventive SDC was associated with good clinical outcomes in patients with cerebellar infarction and to evaluate its predisposing factors. Methods-Between March 2007 and September 2015, 28 patients underwent preventive SDC. We performed propensity score matching to establish a proper control group among 721 patients with cerebellar infarction during the same period. Group A (n=28) consists of those who underwent preventive SDC, and group B (n=56) consists of those who did not undergo preventive SDC. We analyzed and compared clinical outcomes between groups. Results-Clinical outcomes were better in group A than in group B at discharge (P=0.048) and 12-month follow-up (P=0.030).Group B had more deaths within 12 months than group A (log-rank, P<0.05). Logistic regression analysis showed that preventive SDC (odds ratio, 4.815; P=0.009) and the absence of brain stem infarction (odds ratio, 2.862; P=0.033) were independently associated with favorable outcomes (modified Rankin Scale score of 0-2) at 12-month follow-up. Conclusions-Favorable clinical outcomes including overall survival can be expected after preventive SDC in patients with a volume ratio between 0.25 and 0.33 and the absence of brain stem infarction. Among these patients, preventive SDC might be better than the best medical treatment alone.

Decompressive craniectomy for acute ischemic stroke

“…Kim and co-workers published results of a retrospective matched case-control study [63]. The surgical patients were treated with suboccipital DC and additionally 50% received an external ventricular drain (EVD) and 57% a debridement of infarcted tissue.…”

Indications for Surgical Intervention in the Treatment of Ischemic Stroke

“…In comparison to the role of DHC for malignant MCA infarction, the role of suboccipital decompressive craniectomy (SDC) for malignant cerebellar infarction is less documented in literature. As described in Beez et al (31), the best available evidence derives from one retrospective case-control study, several case series, and a recent meta-analysis (32)(33)(34)(35).…”

“…The retrospective matched case control study, published by Kim and colleagues, compared clinical outcomes between 28 patients who underwent preventive SDC for cerebellar infarction with 56 patients who did not undergo the procedure with cerebellar infarction (32). Selection criteria included initial GCS ≥9 without clinical deterioration within 72 hours from onset and a cerebellar infarction volume ratio between 0.25 and 0.33 on neuroimaging (volume ratio = cerebellar infarction volume / total cerebellar volume).…”

Outcomes following Suboccipital Decompressive Craniectomy for Posterior Fossa Stroke with Malignant Cerebellar Oedema: A Case Series and Review of the Literature

“…SDC has been reported in the literature since as early as 1956 [8,9], with subsequent work by Lehrich, et al [10] in 1970 further demonstrating the potential role in mortality reduction. Current evidence is still limited to retrospective case series [11,12], with no randomised control trials available. A recent meta-analysis, published in 2017, identified eleven observational studies with 283 patients and found that SDC has benefit as a lifesaving procedure, but patient selection based on certain factors such as age and unilateral infarction could further improve outcomes, however further evidence is still required [13].…”