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Surgical treatment of patients with unilateral cerebellar infarcts : clinical outcome and prognostic factors

Tsitsopoulos, Parmenion P; Tobieson, Lovisa; Enblad, Per and Marklund, Niklas LU (2011) In Acta Neurochirurgica 153(10). p.83-2075
Abstract

BACKGROUND: There are limited data on the long-term outcome and on factors influencing the prognosis in patients with cerebellar infarcts treated with surgical decompression.

METHODS: Thirty-two patients (age 64.3 ± 9.9 years) with expansive unilateral cerebellar infarcts were retrospectively evaluated. All patients were treated with ventriculostomy, suboccipital decompressive craniectomy and removal of the necrotic tissue. The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS) scores evaluated the level of consciousness during hospitalization, while the modified Rankin Scale (mRS) was used for the 6-month and long-term outcome. Predicting factors were analyzed using a univariate logistic regression model.

RESULTS:... (More)

BACKGROUND: There are limited data on the long-term outcome and on factors influencing the prognosis in patients with cerebellar infarcts treated with surgical decompression.

METHODS: Thirty-two patients (age 64.3 ± 9.9 years) with expansive unilateral cerebellar infarcts were retrospectively evaluated. All patients were treated with ventriculostomy, suboccipital decompressive craniectomy and removal of the necrotic tissue. The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS) scores evaluated the level of consciousness during hospitalization, while the modified Rankin Scale (mRS) was used for the 6-month and long-term outcome. Predicting factors were analyzed using a univariate logistic regression model.

RESULTS: The median time from ictus to surgery was 48.4 h (range 8-120 h). Before surgery, the median GCS score was 9 (3-13). At discharge, the GCS score improved to 13.6 (7-15) (p < 0.05 compared to preoperative scores). At the long-term follow-up (median 67.5 months), ten patients were dead, and 77% of survivors had a good outcome (mRS score of ≤2). The number of days on a ventilator and the GCS score prior to surgery and at discharge were strong predictors of clinical outcome (p < 0.05), although one third of patients with a GCS ≤ 8 at the time of surgery had a good long-term outcome. In patients ≥70 years old, 50% had a good long-term outcome, and advanced age was not associated with a bad result (p > 0.05).

CONCLUSIONS: Our results imply that surgical evacuation of significant cerebellar infarctions may be considered also in patients with advanced age and/or a decreased level of consciousness.

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author
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Contribution to journal
publication status
published
keywords
Adult, Aged, Brain Infarction, Cerebellar Diseases, Cerebellum, Decompression, Surgical, Female, Humans, Male, Middle Aged, Neurosurgical Procedures, Prognosis, Radiography, Retrospective Studies, Treatment Outcome, Journal Article, Research Support, Non-U.S. Gov't
in
Acta Neurochirurgica
volume
153
issue
10
pages
83 - 2075
publisher
Springer
external identifiers
  • scopus:80054116239
ISSN
0001-6268
DOI
10.1007/s00701-011-1120-4
language
English
LU publication?
no
id
1d381036-f04d-436b-82c3-488a90851bff
date added to LUP
2018-03-03 15:23:06
date last changed
2018-10-03 12:11:03
@article{1d381036-f04d-436b-82c3-488a90851bff,
  abstract     = {<p>BACKGROUND: There are limited data on the long-term outcome and on factors influencing the prognosis in patients with cerebellar infarcts treated with surgical decompression.</p><p>METHODS: Thirty-two patients (age 64.3 ± 9.9 years) with expansive unilateral cerebellar infarcts were retrospectively evaluated. All patients were treated with ventriculostomy, suboccipital decompressive craniectomy and removal of the necrotic tissue. The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS) scores evaluated the level of consciousness during hospitalization, while the modified Rankin Scale (mRS) was used for the 6-month and long-term outcome. Predicting factors were analyzed using a univariate logistic regression model.</p><p>RESULTS: The median time from ictus to surgery was 48.4 h (range 8-120 h). Before surgery, the median GCS score was 9 (3-13). At discharge, the GCS score improved to 13.6 (7-15) (p &lt; 0.05 compared to preoperative scores). At the long-term follow-up (median 67.5 months), ten patients were dead, and 77% of survivors had a good outcome (mRS score of ≤2). The number of days on a ventilator and the GCS score prior to surgery and at discharge were strong predictors of clinical outcome (p &lt; 0.05), although one third of patients with a GCS ≤ 8 at the time of surgery had a good long-term outcome. In patients ≥70 years old, 50% had a good long-term outcome, and advanced age was not associated with a bad result (p &gt; 0.05).</p><p>CONCLUSIONS: Our results imply that surgical evacuation of significant cerebellar infarctions may be considered also in patients with advanced age and/or a decreased level of consciousness.</p>},
  author       = {Tsitsopoulos, Parmenion P and Tobieson, Lovisa and Enblad, Per and Marklund, Niklas},
  issn         = {0001-6268},
  keyword      = {Adult,Aged,Brain Infarction,Cerebellar Diseases,Cerebellum,Decompression, Surgical,Female,Humans,Male,Middle Aged,Neurosurgical Procedures,Prognosis,Radiography,Retrospective Studies,Treatment Outcome,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {10},
  pages        = {83--2075},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Surgical treatment of patients with unilateral cerebellar infarcts : clinical outcome and prognostic factors},
  url          = {http://dx.doi.org/10.1007/s00701-011-1120-4},
  volume       = {153},
  year         = {2011},
}