Strokectomy and Extensive Cerebrospinal Fluid Drainage for the Treatment of Space-Occupying Cerebellar Ischemic Stroke

Fulvio Tartara, Daniele Bongetta, Elena Virginia Colombo, Carlo Bortolotti, Marco Cenzato, Ermanno Giombelli, Paolo Gaetani, Francesco Zenga, Giulia Pilloni, Alfonso Ciccone, Maria Sessa

Research output: Contribution to journalArticle

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Abstract

Background: Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures are available to create space for the swollen ischemic brain; however, the type and timing of surgical treatments remain topics of debate in the literature. Here we report a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural posterior fossa decompression. Methods: We retrospectively analyzed the clinical and radiographic data of 11 patients with posterior fossa ischemia who underwent surgery at one of our institutions. A statistical analysis was performed to identify potential predictive factors for functional outcome. Results: The mean patient age was 64.7 years. The involved vascular territory was the Posterior inferior cerebellar artery in 9 patients (82%) and the anterior inferior cerebellar artery/superior cerebellar artery in 2 patients (18%). The mean Glasgow Coma Scale score was 13.6 on admission, but 9.3 immediately before surgery. The surgical procedure was performed in a mean of 36.8 minutes after the radiologic diagnosis of space-occupying edema. Clinical outcome at 6 months was good (modified Rankin Scale [mRS] score ≤2) in 9 patients (82%). Surgery-related complications occurred in 2 patients (18%), and these was a single death (9%) not related to the procedure or posterior fossa compression. Matching patients with their mRS outcome evaluation, the sole variable significantly associated with good outcome was age at admission (62.1 vs. 76.5 years; P < 0.05). Conclusions: Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients.

Original languageEnglish
Pages (from-to)e80-e84
JournalWorld Neurosurgery
Volume115
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

Stroke
Therapeutics
Arteries
Craniotomy
Decompression
Edema
Ischemia
Cerebrospinal Fluid Leak
Glasgow Coma Scale
Blood Vessels
Morbidity
Mortality
Brain

Keywords

  • Cerebellar stroke
  • Decompressive craniectomy
  • Ischemic stroke
  • Strokectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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Strokectomy and Extensive Cerebrospinal Fluid Drainage for the Treatment of Space-Occupying Cerebellar Ischemic Stroke. / Tartara, Fulvio; Bongetta, Daniele; Colombo, Elena Virginia; Bortolotti, Carlo; Cenzato, Marco; Giombelli, Ermanno; Gaetani, Paolo; Zenga, Francesco; Pilloni, Giulia; Ciccone, Alfonso; Sessa, Maria.

In: World Neurosurgery, Vol. 115, 01.07.2018, p. e80-e84.

Research output: Contribution to journalArticle

Tartara, Fulvio ; Bongetta, Daniele ; Colombo, Elena Virginia ; Bortolotti, Carlo ; Cenzato, Marco ; Giombelli, Ermanno ; Gaetani, Paolo ; Zenga, Francesco ; Pilloni, Giulia ; Ciccone, Alfonso ; Sessa, Maria. / Strokectomy and Extensive Cerebrospinal Fluid Drainage for the Treatment of Space-Occupying Cerebellar Ischemic Stroke. In: World Neurosurgery. 2018 ; Vol. 115. pp. e80-e84.
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AU - Bongetta, Daniele

AU - Colombo, Elena Virginia

AU - Bortolotti, Carlo

AU - Cenzato, Marco

AU - Giombelli, Ermanno

AU - Gaetani, Paolo

AU - Zenga, Francesco

AU - Pilloni, Giulia

AU - Ciccone, Alfonso

AU - Sessa, Maria

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N2 - Background: Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures are available to create space for the swollen ischemic brain; however, the type and timing of surgical treatments remain topics of debate in the literature. Here we report a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural posterior fossa decompression. Methods: We retrospectively analyzed the clinical and radiographic data of 11 patients with posterior fossa ischemia who underwent surgery at one of our institutions. A statistical analysis was performed to identify potential predictive factors for functional outcome. Results: The mean patient age was 64.7 years. The involved vascular territory was the Posterior inferior cerebellar artery in 9 patients (82%) and the anterior inferior cerebellar artery/superior cerebellar artery in 2 patients (18%). The mean Glasgow Coma Scale score was 13.6 on admission, but 9.3 immediately before surgery. The surgical procedure was performed in a mean of 36.8 minutes after the radiologic diagnosis of space-occupying edema. Clinical outcome at 6 months was good (modified Rankin Scale [mRS] score ≤2) in 9 patients (82%). Surgery-related complications occurred in 2 patients (18%), and these was a single death (9%) not related to the procedure or posterior fossa compression. Matching patients with their mRS outcome evaluation, the sole variable significantly associated with good outcome was age at admission (62.1 vs. 76.5 years; P < 0.05). Conclusions: Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients.

AB - Background: Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures are available to create space for the swollen ischemic brain; however, the type and timing of surgical treatments remain topics of debate in the literature. Here we report a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural posterior fossa decompression. Methods: We retrospectively analyzed the clinical and radiographic data of 11 patients with posterior fossa ischemia who underwent surgery at one of our institutions. A statistical analysis was performed to identify potential predictive factors for functional outcome. Results: The mean patient age was 64.7 years. The involved vascular territory was the Posterior inferior cerebellar artery in 9 patients (82%) and the anterior inferior cerebellar artery/superior cerebellar artery in 2 patients (18%). The mean Glasgow Coma Scale score was 13.6 on admission, but 9.3 immediately before surgery. The surgical procedure was performed in a mean of 36.8 minutes after the radiologic diagnosis of space-occupying edema. Clinical outcome at 6 months was good (modified Rankin Scale [mRS] score ≤2) in 9 patients (82%). Surgery-related complications occurred in 2 patients (18%), and these was a single death (9%) not related to the procedure or posterior fossa compression. Matching patients with their mRS outcome evaluation, the sole variable significantly associated with good outcome was age at admission (62.1 vs. 76.5 years; P < 0.05). Conclusions: Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients.

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