Hornig C R, Rust D S, Busse O, Jauss M, Laun A
Department of Neurology, Justus Liebig University, Giessen, Germany.
Stroke. 1994 Feb;25(2):372-4. doi: 10.1161/01.str.25.2.372.
Because the timing and strategy of surgical intervention in massive cerebellar infarction remains controversial, we report our experience with the management of 52 such patients.
Case records, computed tomographic scans, surgical reports, and angiograms of 52 patients with space-occupying cerebellar infarction defined by computed tomographic criteria were reevaluated with regard to clinical course, etiology, therapeutic management, mortality, and functional outcome.
In most cases clinical deterioration started on the third day after stroke, and a comatose state was reached within 24 hours. Sixteen patients were treated medically, and 30 by suboccipital craniectomy (22 plus ventriculostomy, 12 plus tonsillectomy). Ten patients primarily had ventriculostomy, which in 4 patients was supplemented by craniotomy because of continuing deterioration. Twenty-nine patients made a good recovery, 15 remained disabled, and 8 died. Even comatose patients had a 38% chance of a good recovery with decompressive surgery. Age older than 60 years (P = .0043) and probably initial brain stem signs (P = .0816) and a late clinical stage (P = .0893) were linked with a fatal or disabling outcome.
Decompressive surgery should be the treatment of choice for massive cerebellar infarction causing progressive brain stem signs or impairment of consciousness.
由于大面积小脑梗死手术干预的时机和策略仍存在争议，我们报告了52例此类患者的治疗经验。
对52例符合计算机断层扫描标准的占位性小脑梗死患者的病例记录、计算机断层扫描、手术报告和血管造影进行重新评估，分析其临床病程、病因、治疗管理、死亡率和功能转归。
大多数病例临床恶化始于卒中后第3天，24小时内进入昏迷状态。16例患者接受内科治疗，30例接受枕下开颅手术（22例加做脑室造瘘术，12例加做扁桃体切除术）。10例患者首先接受脑室造瘘术，其中4例因病情持续恶化而加做开颅手术。29例患者恢复良好，15例仍有残疾，8例死亡。即使是昏迷患者，减压手术也有38%的机会恢复良好。年龄大于60岁（P = 0.0043）、可能存在的初始脑干体征（P = 0.0816）和较晚的临床分期（P = 0.0893）与致命或致残结局相关。
减压手术应作为导致进行性脑干体征或意识障碍的大面积小脑梗死的首选治疗方法。
