title: Craniectomy Versus Craniotomy for Posterior Fossa Metastases: Complication Profile.
abstract: OBJECTIVE
  Surgical resection of posterior fossa metastases (PFM) includes either suboccipital craniotomy or suboccipital craniectomy. The optimal surgical technique is yet to be defined. We examined the association between the chosen surgical approach and the occurrence of postoperative complications.
  
  
  METHODS
  We retrospectively evaluated medical records and imaging characteristics of patients who underwent resection of newly diagnosed PFM between 2003 and 2014 in our medical center to identify covariates that significantly affected postoperative complications.
  
  
  RESULTS
  Of 917 patients with brain metastases, 88 patients underwent surgery for PFM and were included in the study. Craniectomy was performed in 54 cases (61%). Urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion was performed in 4 patients (4.5%). Postoperative complications included postoperative central nervous system infection (n = 10 [12%]), cerebrospinal fluid leak (n = 3 [4%]), wound dehiscence (n = 6 [7%]), and long-term pseudomeningocele (n = 12 [14%]). The perioperative mortality rate was 2.3% (n = 2). Multivariate analysis that included patient baseline characteristics, imaging study parameters, and surgical approaches demonstrated that suboccipital craniectomy was associated with more postoperative complications (P = 0.03, odds ratio = 4.48, 95% confidence interval = 1.14-17.6). There was no correlation between patient baseline characteristics or surgical technique with the need for urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion.
  
  
  CONCLUSIONS
  Suboccipital craniotomy may be associated with a lower incidence of postoperative morbidity compared with suboccipital craniectomy and should be considered as the preferred approach for the resection of PFM.
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Amir
authors: A
authors: Hadanny
authors: Department of Hematology and Bone Marrow Transplantation, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Uri
authors: U
authors: Rozovski
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Erez
authors: E
authors: Nossek
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Yuval
authors: Y
authors: Shapira
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Ido
authors: I
authors: Strauss
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Andrew A
authors: AA
authors: Kanner
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Razi
authors: R
authors: Sitt
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Zvi
authors: Z
authors: Ram
authors: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel. Electronic address: talsh5@gmail.com.
authors: Tal
authors: T
authors: Shahar
mesh_terms: D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects; D056424:Decompressive Craniectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D047368:Tumor Burden
keywords: Brain metastases; Complications; Craniectomy; Craniotomy; Posterior fossa; Suboccipital