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Published on: August 11, 2015
Preventive Suboccipital Decompressive Craniectomy for Cerebellar Infarction: A Retrospective-Matched Case-Control
Myeong Jin Kim1, Sang Kyu Park1, Jihye Song1
1From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Background And Purpose:
No evidence is available on the benefits of preventive suboccipital decompressive craniectomy (SDC) for patients with cerebellar infarction. The purpose of this matched case-control study was to investigate whether preventive SDC was associated with good clinical outcomes in patients with cerebellar infarction and to evaluate its predisposing factors.
Methods:
Between March 2007 and September 2015, 28 patients underwent preventive SDC. We performed propensity score matching to establish a proper control group among 721 patients with cerebellar infarction during the same period. Group A (n=28) consists of those who underwent preventive SDC, and group B (n=56) consists of those who did not undergo preventive SDC. We analyzed and compared clinical outcomes between groups.
Results:
Clinical outcomes were better in group A than in group B at discharge (P=0.048) and 12-month follow-up (P=0.030). Group B had more deaths within 12 months than group A (log-rank, P<0.05). Logistic regression analysis showed that preventive SDC (odds ratio, 4.815; P=0.009) and the absence of brain stem infarction (odds ratio, 2.862; P=0.033) were independently associated with favorable outcomes (modified Rankin Scale score of 0-2) at 12-month follow-up.
Conclusions:
Favorable clinical outcomes including overall survival can be expected after preventive SDC in patients with a volume ratio between 0.25 and 0.33 and the absence of brain stem infarction. Among these patients, preventive SDC might be better than the best medical treatment alone.
