Surgical treatment of cerebellar infarction: long-term outcomes and prognostic factors

Cerebellar infarcts are medically curable diseases, and the majority of patients show mild symptoms, such as dizziness, vertigo, and ataxia [1]. However, a subgroup of patients with severe cerebellar swelling show clinical or radiological deterioration within several days after the onset of cerebellar stroke. Large cerebellar infarctions can result in a space-occupying mass effect and increase posterior fossa pressure. This pathophysiologic phenomenon can cause critObjective: Patients with cerebellar infarction showing neurological deterioration require surgical treatment for posterior fossa decompression. Although decompressive suboccipital craniectomy (DSC) with or without ventriculostomy is recommended, long-term follow-up data on the outcomes of DSC are insufficient, and some prognostic factors have yet to be elucidated. We analyzed the longterm clinical outcomes and prognostic factors of decompressive surgery in patients with severe cerebellar infarction. Methods: In this retrospective review of patients with cerebellar infarction with severe swelling who underwent surgical treatment between 2008 and 2018, 33 eligible patients were investigated to determine the neurological, surgical, and radiological parameters that could affect long-term outcomes. In assessments based on modified Rankin scale (mRS) scores, patients were considered to show a poor outcome if their score was 4 points or higher and a good prognosis if their score was less than 4 points. Results: The initial neurological assessment was based on the Glasgow coma scale score. All patients underwent DSC, and necrosectomy was performed in 10 patients. Nine patients underwent external ventricular drainage to prevent upward transtentorial herniation and hydrocephalus progression. In long-term prognostic assessments conducted using the mRS score 2 years after surgery, 21 of the 30 surviving patients had scores of less than 4, while the other 9 had mRS scores of 4 or higher. In particular, 4 out of 5 patients with brain stem infarction remained severely disabled. Conclusion: We analyzed several factors and found that the presence of brainstem infarction influenced long-term prognoses after DSC.