Size of decompressive craniectomy as prognostic factor in space-occupying ischemic cerebellar stroke -a multicentric retrospective study.
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Hernández-Durán Silvia, Walter Johannes, Dubinski Daniel, Alhalabi Obada T, Arsenovic Milos, Cantre Daniel, Dinc Nazife, Dremel Judith, Etminan Nima, Freiman Thomas M, Ferdowssian Kiarash, Güresir Erdem, Hackenberg Katharina A M, Hamed Motaz, Kramer Andreas, Krämer Christopher, Kranawetter Beate, Lampmann Tim, Neumeister Anne, Rafaelian Artem, Ringel Florian, Rohde Veit, Schäfer Jan Hendrik, Schwake Michael, Senft Christian, Storch Alexander, Thiel Moritz, Turgut Merih, Unterberg Andreas W, Vajkoczy Peter, Vatter Hartmut, Vychopen Martin, Wach Johannes, Wittstock Matthias, Gessler Florian, Won Sae-Yeon
Аннотация
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.