Abstract
OBJECTIVE: The management of cerebellar infarctions is controversial. The aim of this study was to determine which patients require surgical treatment and which surgical procedure should be performed when a patient with a cerebellar infarction exhibits progressive neurological deterioration. METHODS: A total of 44 patients (24 male and 20 female patients; average age, 56 yr) were treated at our institution for cerebellar infarctions in the past 8 years. Twenty-five patients received conservative treatment; two patients who were deeply comatose received no treatment. The remaining 17 patients underwent emergency surgery. Of those 17 patients, 8 underwent external ventricular drainage alone, 5 underwent external ventricular drainage as the first treatment plus secondary suboccipital craniectomy, and 4 underwent suboccipital craniectomy, with removal of necrotic tissue, as the first treatment. RESULTS: Of the 25 conservatively treated patients, 20 experienced good outcomes, 4 experienced moderate outcomes, and 1 died as a result of pulmonary embolism. Of the 17 surgically treated patients, 10 experienced good functional recoveries (7 treated with external ventricular drainage only and 3 treated with drainage followed by suboccipital craniectomy) and 3 survived with mild neurological deficits (one patient underwent ventriculostomy, one suboccipital craniectomy plus external ventricular drainage, and one suboccipital craniectomy only). The overall mortality rate was 13.6% (6 of 44 patients). CONCLUSION: For patients with worsening levels of consciousness and radio-logically evident ventricular enlargement, we recommend external ventricular drainage. We reserve surgical resection of necrotic tissue for patients whose clinical status worsens despite ventriculostomy, those for whom worsening is accompanied by signs of brainstem compression, and those with tight posterior fossae.
| Original language | English |
|---|---|
| Pages (from-to) | 1061-1066 |
| Number of pages | 6 |
| Journal | Neurosurgery |
| Volume | 53 |
| Issue number | 5 |
| Publication status | Published - Nov 2003 |
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Keywords
- Brainstem compression
- Cerebellar infarction
- Treatment
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Management of Acute Cerebellar Infarction : One Institution's Experience. / Raco, Antonino; Caroli, Emanuela; Isidori, Alessandra; Vangelista, Tommaso; Salvati, Maurizio; Lawton, Michael T.; Barrow, Daniel L.; Macdonald, R. Loch; Ogilvy, Christopher S.
In: Neurosurgery, Vol. 53, No. 5, 11.2003, p. 1061-1066.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Management of Acute Cerebellar Infarction
T2 - One Institution's Experience
AU - Raco, Antonino
AU - Caroli, Emanuela
AU - Isidori, Alessandra
AU - Vangelista, Tommaso
AU - Salvati, Maurizio
AU - Lawton, Michael T.
AU - Barrow, Daniel L.
AU - Macdonald, R. Loch
AU - Ogilvy, Christopher S.
PY - 2003/11
Y1 - 2003/11
N2 - OBJECTIVE: The management of cerebellar infarctions is controversial. The aim of this study was to determine which patients require surgical treatment and which surgical procedure should be performed when a patient with a cerebellar infarction exhibits progressive neurological deterioration. METHODS: A total of 44 patients (24 male and 20 female patients; average age, 56 yr) were treated at our institution for cerebellar infarctions in the past 8 years. Twenty-five patients received conservative treatment; two patients who were deeply comatose received no treatment. The remaining 17 patients underwent emergency surgery. Of those 17 patients, 8 underwent external ventricular drainage alone, 5 underwent external ventricular drainage as the first treatment plus secondary suboccipital craniectomy, and 4 underwent suboccipital craniectomy, with removal of necrotic tissue, as the first treatment. RESULTS: Of the 25 conservatively treated patients, 20 experienced good outcomes, 4 experienced moderate outcomes, and 1 died as a result of pulmonary embolism. Of the 17 surgically treated patients, 10 experienced good functional recoveries (7 treated with external ventricular drainage only and 3 treated with drainage followed by suboccipital craniectomy) and 3 survived with mild neurological deficits (one patient underwent ventriculostomy, one suboccipital craniectomy plus external ventricular drainage, and one suboccipital craniectomy only). The overall mortality rate was 13.6% (6 of 44 patients). CONCLUSION: For patients with worsening levels of consciousness and radio-logically evident ventricular enlargement, we recommend external ventricular drainage. We reserve surgical resection of necrotic tissue for patients whose clinical status worsens despite ventriculostomy, those for whom worsening is accompanied by signs of brainstem compression, and those with tight posterior fossae.
AB - OBJECTIVE: The management of cerebellar infarctions is controversial. The aim of this study was to determine which patients require surgical treatment and which surgical procedure should be performed when a patient with a cerebellar infarction exhibits progressive neurological deterioration. METHODS: A total of 44 patients (24 male and 20 female patients; average age, 56 yr) were treated at our institution for cerebellar infarctions in the past 8 years. Twenty-five patients received conservative treatment; two patients who were deeply comatose received no treatment. The remaining 17 patients underwent emergency surgery. Of those 17 patients, 8 underwent external ventricular drainage alone, 5 underwent external ventricular drainage as the first treatment plus secondary suboccipital craniectomy, and 4 underwent suboccipital craniectomy, with removal of necrotic tissue, as the first treatment. RESULTS: Of the 25 conservatively treated patients, 20 experienced good outcomes, 4 experienced moderate outcomes, and 1 died as a result of pulmonary embolism. Of the 17 surgically treated patients, 10 experienced good functional recoveries (7 treated with external ventricular drainage only and 3 treated with drainage followed by suboccipital craniectomy) and 3 survived with mild neurological deficits (one patient underwent ventriculostomy, one suboccipital craniectomy plus external ventricular drainage, and one suboccipital craniectomy only). The overall mortality rate was 13.6% (6 of 44 patients). CONCLUSION: For patients with worsening levels of consciousness and radio-logically evident ventricular enlargement, we recommend external ventricular drainage. We reserve surgical resection of necrotic tissue for patients whose clinical status worsens despite ventriculostomy, those for whom worsening is accompanied by signs of brainstem compression, and those with tight posterior fossae.
KW - Brainstem compression
KW - Cerebellar infarction
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=0242582320&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0242582320&partnerID=8YFLogxK
M3 - Article
C2 - 14580272
AN - SCOPUS:0242582320
VL - 53
SP - 1061
EP - 1066
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 5
ER -