Surgical management of comatose patients with cerebellar infarction

A series of 20 patients with cerebellar infarction were classified into four groups based on the clinical and CT findings. Two comatose patients who developed acute hydrocephalus (Group 2) are presented and were successfully treated with external ventricular drainage (EVD) alone. Continuous post-operative monitoring of intracranial pressure (ICP) demonstrated that EVD had sufficiently controlled ICP and therefore suboccipital decompression of the cerebellum was not indicated even though the patients were not immediately responsive to EVD. Both patients made a gradual recovery: a 57-year-old woman, independently ambulatory, was discharged to her home and a 76-year-old woman, ambulatory with assistance, was discharged to a rehabilitation hospital. The results of our two cases suggest that EVD should be the first treatment in cases of cerebellar infarction with cerebellar swelling or oedema accompanied by hydrocephalus. Posterior fossa decompression and removal of infarcted cerebellar tissue should be indicated only in cases where ICP can not be controlled by EVD, even if there is no immediate recovery of the patient's impaired consciousness. Reviewing the literature pertinent to our two cases, the use of ventricular drainage alone in the management of cerebellar infarction with ischaemic cerebellar swelling is discussed.