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Posterior Fossa Surgery for Stroke: Differences in Outcomes Between Cerebellar Hemorrhage and Infarcts
Lester Lee1, Daniel Loh2, Nicolas Kon Kam King1
1Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
Insights
Posterior fossa surgery outcomes differ between cerebellar hemorrhage and infarct patients. Hemorrhage cases show worse results and higher tracheostomy rates, while rehabilitation improves functional outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Posterior fossa surgery is standard for cerebellar strokes with brainstem compression.
- Limited data exists on long-term outcomes following this procedure.
Purpose of the Study:
- To compare 6-month outcomes of posterior fossa surgery for cerebellar hemorrhage versus infarct.
- To identify factors influencing outcomes after posterior fossa surgery.
Main Methods:
- Retrospective analysis of 126 patients undergoing posterior fossa surgery.
- Patients grouped by good (mRS 0-3) or poor (mRS 4-6) 6-month outcomes.
- Analysis of clinical factors including age, GCS, comorbidities, and surgical details.
Main Results:
- Cerebellar hemorrhage patients had worse outcomes (OR 3.04) and higher mortality (OR 2.20) at 6 months compared to infarct patients.
- Older age, low Glasgow Coma Scale (GCS) score (≤8), and tracheostomy predicted poor outcomes.
- Improved outcomes were associated with shorter hospital stays and discharge to rehabilitation.
Conclusions:
- Cerebellar hemorrhage patients undergoing posterior fossa surgery experience poorer outcomes and increased need for tracheostomy than infarct patients.
- Early rehabilitation is crucial for improving functional recovery after posterior fossa surgery.
Background:
Posterior fossa surgery is the established treatment for large cerebellar strokes with brainstem compression. Despite this, there is a paucity of data for long-term outcomes.
Methods:
A retrospective analysis of patients who underwent posterior fossa surgery for cerebellar hemorrhages and infarcts was performed to compare their difference in 6-month outcomes and to identify factors that affect outcomes. Patients were dichotomized into groups with good outcomes (modified Rankin scale [mRS] score 0-3) or poor outcomes (mRS score 4-6). Sex, age, preoperative Glasgow Coma Scale score, Charleston comorbidity index, time to surgery, intraventricular hemorrhage, surgical complications, length of intensive care unit and hospital stay, shunt dependence, and tracheostomy rates were analyzed.
Results:
In total, 126 patients were recruited: 76 in hemorrhage group and 50 in infarct group. There was a greater mortality in the hemorrhage group (P = 0.0730). At 6 months, more patients in the hemorrhage group had poor outcomes (P = 0.0074, odds ratio 3.04) and greater mortality (P = 0.0730, odds ratio 2.20). More patients in the hemorrhage group required a tracheostomy (P = 0.0245). Factors predictive of poor outcome include older age (P = 0.0108), Glasgow Coma Scale score ≤8 (P = 0.0011), and tracheostomy (P = 0.0269). A total of 69.2% of patients had improvements in mRS scores at 6 months. Shorter length of stay (P = 0.0003) and discharge to a rehabilitation hospital (P = 0.0001) were predictive of functional improvement.
Conclusions:
Patients who underwent posterior fossa surgery for cerebellar hemorrhage had worse outcomes compared with patients with cerebellar infarcts and were more likely to require a tracheostomy. Rehabilitation helped to improved outcomes.
