Preventive Suboccipital Decompressive Craniectomy for Cerebellar Infarction: A Retrospective-Matched Case-Control Study.
No evidence is available on the benefits of preventive suboccipital decompressive craniectomy (SDC) for patients with cerebellar infarction. The purpose of this matched case-control study was to investigate whether preventive SDC was associated with good clinical outcomes in patients with cerebellar infarction and to evaluate its predisposing factors.



Between March 2007 and September 2015, 28 patients underwent preventive SDC. We performed propensity score matching to establish a proper control group among 721 patients with cerebellar infarction during the same period. Group A (n=28) consists of those who underwent preventive SDC, and group B (n=56) consists of those who did not undergo preventive SDC. We analyzed and compared clinical outcomes between groups.



Clinical outcomes were better in group A than in group B at discharge (P=0.048) and 12-month follow-up (P=0.030). Group B had more deaths within 12 months than group A (log-rank, P<0.05). Logistic regression analysis showed that preventive SDC (odds ratio, 4.815; P=0.009) and the absence of brain stem infarction (odds ratio, 2.862; P=0.033) were independently associated with favorable outcomes (modified Rankin Scale score of 0-2) at 12-month follow-up.



Favorable clinical outcomes including overall survival can be expected after preventive SDC in patients with a volume ratio between 0.25 and 0.33 and the absence of brain stem infarction. Among these patients, preventive SDC might be better than the best medical treatment alone.
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Myeong Jin
MJ
Kim
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Sang Kyu
SK
Park
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Jihye
J
Song
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Se-Yang
SY
Oh
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Yong Cheol
YC
Lim
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Sook Yong
SY
Sim
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.).
Yong Sam
YS
Shin
From the Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (M.J.K.); Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea (S.K.P.); Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Korea (J.S.); Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea (S.-y.O.); Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea (Y.C.L.); Department of Neurosurgery, Inje University Seoul Paik Hospital, Korea (S.Y.S.); Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea (Y.S.S.); Department of Neurosurgery, Gangnam Severance Hospital, Seoul, Korea (J.C.); and Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea (J.C.). ns.joonho.chung@gmail.com.
Joonho
J
Chung
D000368:Aged; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
brain infarction; cerebellar diseases; decompressive craniectomy; infarction; propensity score