Lindeskog Desirée, Lilja-Cyron Alexander, Kelsen Jesper, Juhler Marianne
Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Clin Neurol Neurosurg. 2019 Jan;176:47-52. doi: 10.1016/j.clineuro.2018.11.023. Epub 2018 Dec 1.
Suboccipital decompressive craniectomy (SDC) is considered the best treatment option in patients with space-occupying cerebellar infarction and clinical signs of deterioration. The primary purpose of this study was to evaluate long-term functional outcome in patients one year after SDC for space-occupying cerebellar infarction, and secondly, to determine factors associated with outcome.
All patients treated with SDC due to space-occupying cerebellar infarction between January 2009 and October 2015 were included in the study. Data was retrospectively collected from patient records, CT/MRI scans and surgical protocols. Long-term functional outcome was determined by the modified Rankin Scale (mRS) and mRS ≥ 4 was defined as unfavorable outcome.
Twenty-two patients (16 male, 6 female) were included in the study. Median age was 53 years. Nine patients were treated with external ventricular drainage as an initial treatment attempt prior to SDC. Median time from symptom onset (stroke ictus) to initiation of the SDC surgery was 48 h (IQR 28-99 hours) and median GCS before SDC was 8 (IQR 5-10). At follow up, median mRS was 3 (IQR 2-6). Outcome was favorable (mRS 0-3) in 12 patients and unfavorable in 10 (3 with major disability, 7 dead). Brainstem infarction and bilateral cerebellar infarction were associated with unfavorable outcome.
In this small study, functional long-term outcome in patients with space-occupying cerebellar infarction treated by SDC was acceptable and comparable to previously published results (favorable outcome in 54% of patients). Brainstem infarction and bilateral cerebellar infarction were associated with unfavorable outcome.
枕下减压颅骨切除术（SDC）被认为是治疗有占位性小脑梗死且有临床恶化体征患者的最佳选择。本研究的主要目的是评估SDC治疗占位性小脑梗死后一年患者的长期功能结局，其次是确定与结局相关的因素。
纳入2009年1月至2015年10月期间因占位性小脑梗死接受SDC治疗的所有患者。数据通过回顾性收集患者记录、CT/MRI扫描和手术方案获得。长期功能结局通过改良Rankin量表（mRS）确定，mRS≥4被定义为不良结局。
本研究纳入22例患者（16例男性，6例女性）。中位年龄为53岁。9例患者在SDC前作为初始治疗尝试接受了脑室外引流。从症状发作（卒中发作）到开始SDC手术的中位时间为48小时（四分位间距28 - 99小时），SDC前的中位格拉斯哥昏迷量表（GCS）评分为8分（四分位间距5 - 10）。随访时，中位mRS为3分（四分位间距2 - 6）。12例患者结局良好（mRS 0 - 3），10例患者结局不良（3例有严重残疾，7例死亡）。脑干梗死和双侧小脑梗死与不良结局相关。
在这项小型研究中，SDC治疗占位性小脑梗死患者的长期功能结局是可以接受的，与先前发表的结果相当（54%的患者结局良好）。脑干梗死和双侧小脑梗死与不良结局相关。
