Strokectomy and extensive cerebro-spinal fluid drainage for the treatment of space-occupying cerebellar ischemic strokes.

Strokectomy and extensive cerebro-spinal fluid drainage for the treatment of space-occupying cerebellar ischemic strokes.

World Neurosurg. 2018 Apr 03;:

Authors: Tartara F, Bongetta D, Colombo EV, Bortolotti C, Cenzato M, Giombelli E, Gaetani P, Zenga F, Pilloni G, Ciccone A, Sessa M

Abstract
BACKGROUND: and Purpose: Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures have been reported to create space for the swollen ischemic brain; still, both the type and timing of surgical treatments are debated in literature. We present here a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebro-spinal fluid drainage without osteo-dural posterior fossa decompression.
METHODS: We retrospectively analyzed the clinical and radiographic data of 11 patients affected by a posterior fossa ischemia operated at our Institutions. A statistical analysis was performed to identify potential predicting factors for functional outcome.
RESULTS: Mean age was 64.7 years, the vascular territory involved was that of the PICA in 9 cases (82%) and AICA/SCA in 2 (18%). Mean GCS on admission was 13.6, whereas the immediate pre-operative GCS evaluation was of 9.3. The surgical procedure was performed in a mean of 36.8 minutes after the radiological diagnosis of space-occupying edema. Clinical outcome at 6 months was good (mRS ≤ 2) in 9 patients (82%). We report surgery-related complications in 2 patients (18%) and a single case of death (9%) non-related to the procedure and posterior fossa compression. Matching patients with their mRS outcome evaluation the only variable significantly associated with good outcome was age at admission: 62.1 vs 76.5 (p< 0.05).
CONCLUSIONS: Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow a satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients.

PMID: 29625312 [PubMed - as supplied by publisher]

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