Microsurgical infarctectomy for cerebellar pseudotumoral stroke: series of six cases and exploratory comparison versus suboccipital craniectomy
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Abstract
Introduction: Cerebellar infarction with mass effect (pseudotumoral) may require early decompression. The microsurgical infarctectomy (MI) is considered as an alternative to decompressive suboccipital craniectomy (DSOC) + External ventricular drain (EVD). Aim: To describe the experience of a center with MI and add an exploratory comparison with a historical sample treated with SOCD + EVD. Methods: Retrospective series of 6 patients undergoing cerebellar infarctectomy (2016-2019). Clinical and imaging records were reviewed; outcomes: use of critical care units (ICU/IMCU), hospital stay, complications and neurological status at discharge. A non-inferential comparison was made with 5 historical controls (2012-2015) managed with SOCD + EVD. The Jauss CT score were used to quantify the mass effect. Results: 6 MI where made; 1/6 presented a post operative complication. Admission to ICU 2/6 (MI) vs 5/5 (SOCD + EVD). The average lenght of hospital stay observed was 18,2 days (MI) vs 49 days (SOCD + EVD). The average change in the Jauss Ct score: 2,7 points (MI: 7,5^4,8) vs 1,2 (SOCD + EVD 8,0^6,8). In the subgroup GCS = 13 the neurological status at discharge was comparable. Conclusions: The MI was shown to be technically feasible in this context and was associated with shorter care trajectories and less complications in comparisson with historical controls without implying any superiority. The findings are hypothesis-generating and require confirmation in prospective and comparative studies.
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Cerebellar stroke, nfarctectomy, necrosectomy, suboccipital craniectomy, external ventricular drain, obstructive hydrocephalus, posterior fossa surgery, Puerto Montt Hospital
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