Strokectomy and Extensive Cerebrospinal Fluid Drainage for the Treatment of Space-Occupying Cerebellar Ischemic Stroke.

Abstract

BACKGROUND:

Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures are available to create space for the swollen ischemic brain; however, the type and timing of surgical treatments remain topics of debate in the literature. Here we report a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural posterior fossa decompression.

METHODS:

We retrospectively analyzed the clinical and radiographic data of 11 patients with posterior fossa ischemia who underwent surgery at one of our institutions. A statistical analysis was performed to identify potential predictive factors for functional outcome.

RESULTS:

The mean patient age was 64.7 years. The involved vascular territory was the Posterior inferior cerebellar artery in 9 patients (82%) and the anterior inferior cerebellar artery/superior cerebellar artery in 2 patients (18%). The mean Glasgow Coma Scale score was 13.6 on admission, but 9.3 immediately before surgery. The surgical procedure was performed in a mean of 36.8 minutes after the radiologic diagnosis of space-occupying edema. Clinical outcome at 6 months was good (modified Rankin Scale [mRS] score ≤2) in 9 patients (82%). Surgery-related complications occurred in 2 patients (18%), and these was a single death (9%) not related to the procedure or posterior fossa compression. Matching patients with their mRS outcome evaluation, the sole variable significantly associated with good outcome was age at admission (62.1 vs. 76.5 years; P < 0.05).

CONCLUSIONS:

Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients.

• Authors: Fulvio Tartara, Daniele Bongetta, Elena Virginia Colombo, Carlo Bortolotti, Marco Cenzato, Ermanno Giombelli, Paolo Gaetani, Francesco Zenga, Giulia Pilloni, Alfonso Ciccone, Maria Sessa
• Journal: World neurosurgery (World Neurosurg) Vol. 115 Pg. e80-e84 (Jul 2018) ISSN: 1878-8769 [Electronic] United States
• PMID: 29625312 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (diagnostic imaging, surgery)
• Cerebellar Diseases (diagnostic imaging, surgery)
• Cerebrospinal Fluid Leak (diagnostic imaging, surgery)
• Craniotomy (methods)
• Decompression, Surgical (methods)
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stroke (diagnostic imaging, surgery)
• Treatment Outcome