Treatment of cerebellar infarction by decompressive suboccipital craniectomy.
OBJECTIVE
We present an anecdotal series of 11 patients without past history of stroke with progressive neurological deterioration while on medical therapy for large cerebellar infarctions. Clinical signs of brain stem compression developed in these patients. Computerized tomography of the head confirmed mass effect from brain edema. It was the clinical judgment of the neurologists and neurosurgeons that each of these 11 patients would expire without surgical intervention.


METHODS
All 11 patients (seven men, four women; mean age, 54 years) were treated with suboccipital craniectomy for decompression and temporary ventriculostomy for cerebrospinal fluid pressure monitoring and drainage.


RESULTS
Seven patients demonstrated neurological improvement on the first postoperative day. Two patients returned to their previous jobs 3 months after surgery. The Barthel Index indicated that six individuals were functioning with minimal assistance within a follow-up period of 16-60 months. The remaining three were functionally dependent. No mortality was noted in this series.


CONCLUSIONS
These results suggest that decompressive suboccipital craniectomy may be an effective, lifesaving procedure for malignant cerebellar edema after a large infarction.
Chen
H J
HJ
Department of Surgery, Chang Gung Medical School and Hospital, Kaohsiung, Taiwan, Republic of China.
Lee
T C
TC
Wei
C P
CP
D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012886:Skull / Q000601:surgery*; D014057:Tomography, X-Ray Computed