SPACE-OCCUPYING CEREBELLAR INFARCTION - CLINICAL COURSE AND PROGNOSIS

Background and Purpose Because the timing and strategy of surgical int ervention in massive cerebellar infarction remains controversial, we r eport our experience with the management of 52 such patients. Methods Case records, computed tomographic scans, surgical reports, and angiog rams of 52 patients with space-occupying cerebellar infarction defined by computed tomographic criteria were reevaluated with regard to clin ical course, etiology, therapeutic management, mortality, and function al outcome. Results In most cases clinical deterioration started on th e third day after stroke, and a comatose state was reached within 24 h ours. Sixteen patients were treated medically, and 30 by suboccipital craniectomy (22 plus ventriculostomy, 12 plus tonsillectomy). Ten pati ents primarily had ventriculostomy, which in 4 patients was supplement ed by craniotomy because of continuing deterioration. Twenty-nine pati ents made a good recovery, 15 remained disabled, and 8 died. Even coma tose patients had a 38% chance of a good recovery with decompressive s urgery. Age older than 60 years (P=.0043) and probably initial brain s tem signs (P=.0816) and a late clinical stage (P=.0893) were linked wi th a fatal or disabling outcome. Conclusions Decompressive surgery sho uld be the treatment of choice for massive cerebellar infarction causi ng progressive brain stem signs or impairment of consciousness.