Surgical treatment of patients with unilateral cerebellar infarcts: clinical outcome and prognostic factors
BACKGROUND AND PURPOSE Surgical management of space-occupying cerebellar infarction is still controversial. Data on long-term outcome are lacking. The objective of this study was (1) to evaluate outcome after at least 3 years poststroke in patients with space-occupying cerebellar infarction treated by ventriculostomy/extraventricular drainage (EVD) or suboccipital decompressive craniectomy (SDC), or both, and (2) to determine predicting factors for outcome. METHODS In this retrospective single-center study 56 consecutive patients with acute space-occupying cerebellar infarction treated surgically between 1996 and 2005 were included. Baseline data included clinical findings, Glasgow Coma Scale on admission and before surgery, NIHSS on admission, mass effects on neuroimaging, and surgical treatment strategies. Modified Rankin Scale, NIHSS, and Scale for the Assessment and Rating of Ataxia were used to assess outcome. RESULTS 39.3% of patients had died, 51.8% had a mRS < or =3, 35.7% had a mRS < or =2, 28.6% had a mRS < or =1. There were no significant differences in survival between treatment groups. In multivariate analysis age and mRS score at discharge were the most evident independent predictors for outcome. CONCLUSIONS So far this is the largest study on long-term outcome after space-occupying cerebellar infarction. The value of different treatment strategies and prognostic factors for patient selection remain unclear and should be evaluated in larger prospective case-series or registries. To investigate the issue of preventive SDC randomized trials are needed.