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Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction
Thomas Pfefferkorn1, Ursula Eppinger, Jennifer Linn
1Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany. thomas.pfefferkorn@med.uni-muenchen.de
Insights
Suboccipital decompressive craniectomy (SDC) is a safe procedure for malignant cerebellar infarction. While early mortality is significant, long-term outcomes for survivors are acceptable, especially without brain stem involvement.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Malignant cerebellar infarction necessitates urgent intervention.
- Suboccipital decompressive craniectomy (SDC) is a critical procedure for these patients.
- Long-term outcomes following SDC require systematic analysis.
Purpose of the Study:
- To evaluate the long-term functional outcomes and quality of life after SDC.
- To analyze mortality rates associated with SDC for malignant cerebellar infarction.
- To identify factors influencing patient outcomes post-SDC.
Main Methods:
- Retrospective analysis of 57 consecutive patients undergoing SDC for malignant cerebellar infarction (1995-2006).
- Assessment of mortality, functional status (modified Rankin Scale), and quality of life.
- Follow-up duration averaged 4.7 years.
Main Results:
- No fatal procedural complications were observed.
- Early mortality within 6 months was 28%.
- At long-term follow-up, 40% of survivors had good functional independence (mRS 0-2), while 8% had major disability. Brain stem infarction significantly worsened outcomes (HR 9.1, P=0.001).
Conclusions:
- SDC is a safe procedure for malignant cerebellar infarction.
- Early mortality is primarily infarct-related, not procedure-related.
- Long-term outcomes are acceptable, particularly when brain stem infarction is absent.
Background And Purpose:
Suboccipital decompressive craniectomy (SDC) is a life-saving intervention for patients with malignant cerebellar infarction. However, long-term outcome has not been systematically analyzed.
Methods:
In this monocentric retrospective study we analyzed mortality, long-term functional outcome, and quality of life of all consecutive patients that were treated by SDC for malignant cerebellar infarction in our institution between 1995 and 2006.
Results:
A total of 57 patients were identified. All of them were treated by bilateral SDC. An external ventricular drainage was inserted in 82%, necrotic tissue was evacuated in 56% of patients. There were no fatal procedural complications. Five patients were lost for follow-up. In the remaining 52 patients, the mean follow-up interval was 4.7 years (1 to 11 years). Within the first 6 months after surgery 16 of 57 patients (28%) had died. At follow-up, 21 of 52 patients (40%) had died and 4 patients (8%) lived with major disability (mRS 4 or 5). Twenty-one patients (40%) lived functionally independent (mRS 0 to 2). The presence of additional brain stem infarction was associated with poor outcome (mRS > or =4; hazard ratio: 9.1; P=0.001). Quality of life in survivors was moderately lower than in healthy controls.
Conclusions:
SDC is a safe procedure in patients with malignant cerebellar infarction. Infarct- but not procedure-related early mortality is substantial. Long-term outcome in survivors is acceptable, particularly in the absence of brain stem infarction.
