This Article Full Text Full Text (PDF) All Versions of this Article: 40/9/3045    most recent STROKEAHA.109.550871v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Pfefferkorn, T. Articles by Grau, S. PubMed PubMed Citation Articles by Pfefferkorn, T. Articles by Grau, S. Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Other Stroke Treatment - Surgical

(Stroke. 2009;40:3045.)
© 2009 American Heart Association, Inc.

Original Contributions

Long-Term Outcome After Suboccipital Decompressive Craniectomy for Malignant Cerebellar Infarction

Thomas Pfefferkorn, MD; Ursula Eppinger; Jennifer Linn, MD; Tobias Birnbaum, MD; Jürgen Herzog, MD; Andreas Straube, MD; Martin Dichgans, MD Stefan Grau, MD

From the Departments of Neurology (T.P., U.E., T.B., A.S., M.D.), Neuroradiology (J.L.), and Neurosurgery (S.G.), Klinikum Grosshadern, University of Munich, Germany; and Neurologische Klinik (J.H.), Bad Aibling, Germany.

Correspondence to Thomas Pfefferkorn, Klinikum Grosshadern, Department of Neurology, Marchioninistr. 15, 81377 München, Germany. E-mail thomas.pfefferkorn{at}med.uni-muenchen.de

Background and Purpose— Suboccipital decompressive craniectomy (SDC) is a life-saving intervention for patients with malignant cerebellar infarction. However, long-term outcome has not been systematically analyzed.

Methods— In this monocentric retrospective study we analyzed mortality, long-term functional outcome, and quality of life of all consecutive patients that were treated by SDC for malignant cerebellar infarction in our institution between 1995 and 2006.

Results— A total of 57 patients were identified. All of them were treated by bilateral SDC. An external ventricular drainage was inserted in 82%, necrotic tissue was evacuated in 56% of patients. There were no fatal procedural complications. Five patients were lost for follow-up. In the remaining 52 patients, the mean follow-up interval was 4.7 years (1 to 11 years). Within the first 6 months after surgery 16 of 57 patients (28%) had died. At follow-up, 21 of 52 patients (40%) had died and 4 patients (8%) lived with major disability (mRS 4 or 5). Twenty-one patients (40%) lived functionally independent (mRS 0 to 2). The presence of additional brain stem infarction was associated with poor outcome (mRS 4; hazard ratio: 9.1; P=0.001). Quality of life in survivors was moderately lower than in healthy controls.

Conclusions— SDC is a safe procedure in patients with malignant cerebellar infarction. Infarct- but not procedure-related early mortality is substantial. Long-term outcome in survivors is acceptable, particularly in the absence of brain stem infarction.

Key Words: cerebellar infarction • craniectomy • outcome