Size of decompressive craniectomy as prognostic factor in space-occupying ischemic cerebellar stroke -a multicentric
Silvia Hernández-Durán1,2, Johannes Walter3, Daniel Dubinski1
1Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany.
Introduction:
In cases of space-occupying cerebellar ischemic strokes, guidelines recommend suboccipital decompressive surgery (SDC). While in supratentorial hemispheric stroke, the size of the bone flap has been the subject of many studies and ample debate, no studies have been conducted to determine the optimal size of the bone flap to be removed in SDC.
Research Question:
To determine the optimal size of SDC in ischemic cerebellar stroke.
Methods:
This is a multicentric retrospective study of patients undergoing SDC for ischemic cerebellar stroke. SDC size was determined in two perpendicular planes on early postoperative CT scans: (a) maximal lateral extension (L) and (b) maximal craniocaudal extension (CC) in cm. The primary endpoint was functional outcome according to modified Rankin Scale (mRS) at three months. Secondary outcome was mortality at three months, as well as surgical complications.
Results:
A total of 88 patients were included in the final analysis. The mean L diameter of the SDC analyzed was 7 cm (SD 1.5), whereas the mean CC diameter was 4.4 cm (SD .8). When dichotomizing patients based on a threshold of L ≥ 6.5 cm, favorable outcome was more likely in the group with L ≥ 6.5 cm (OR = 3.23, 95%CI 1.02-10.56, p = .045). No statistically significant differences were observed in mortality at three months (OR = .66, 95%CI .24-1.78, p = .40).
Conclusions:
In ischemic cerebellar stroke, a suboccipital craniectomy with a maximum lateral diameter of ≥6.5 cm appears to yield better functional outcomes than smaller ones. Prospective studies are needed to confirm these results.
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