The impact of emergent suboccipital craniectomy upon outcome & prognosis of massive cerebellar infarction: A single institutional study

Objective: The dilemma of management of post-ischemic cerebellar massive swelling is still debatable. This study focuses on the usefulness and prognosticators influencing its surgical outcome in a locality with limited resources. Methods: a sum of 42 patients (36 men, 6 women; mean +/- SD age =66 +/- 13 years, range 43-80 years) who were admitted, and subjected to emergent suboccipital craniectomy (ESC) after radiological evidence of malignant cerebellar swelling were reviewed. Prerequisites were (1) Glasgow Coma Scale (GCS) <= 13 (2) evident brainstem pressure and/or associated obstructive hydrocephalus. CSF diversion was done concurrently or later, depending on what the circumstances dictate. Results: upon approaching the postoperative third month, 36 patients (85.7%) had lived, 25 (59.5%) of whom were independent (modified Rankin scale <= 2). 17 cases (40.4%) were either completely dependent or passed away. Statistical analysis disclosed that the factors influencing the prognosis were: Admission GCS (p < 0.05), Time (from onset to surgery) (p < 0.05), Obstructive hydrocephalus (p < 0.05), and another acute intracranial Infarction (p < 0.01). Conclusions: emergent suboccipital craniectomy (ESC) is indicated for treating post-ischemic cerebellar massive swelling in patients with GCS <= 13. Good prognosis could be attained with (ESC) in those cases with higher GCS, who performed it shortly from the onset, and in absence of elsewhere intracranial infarction. In those who already have obstructive hydrocephalus at the time of surgery, a poor prognosis ensues.