Posterior fossa decompression for stroke: differences in long term outcomes between cerebellar haemorrhage and infarcts
EANS Academy. Loh D. 09/27/19; 276008; EP05045
Daniel Loh
Daniel Loh

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Background: Posterior fossa decompression is performed for treatment of large cerebellar haemorrhages and infarcts with significant mass effect. A retrospective study to investigate the differences in outcomes between such patients who undergo decompressive surgery was performed.
Methods: Patients undergoing posterior fossa decompression from Oct 2006-Nov 2017 were recruited. Medical notes and radiological findings were reviewed. Outcomes were assessed using the Modified Rankin Scale (mRS). Grades 0-3 were defined as good outcome; 4-6 as poor outcome. Variables such as sex, age, preoperative Glasgow Coma Scale, Charleson Comorbidity Score, time to surgery from admission, complications, ICU and total length of stay, shunt dependence, tracheostomy and rehabilitation were included to identify factors that may result in poor outcome. Haematoma size, intraventricular extension and degree of evacuation were recorded for the haemorrhage subgroup. Multivariate step-wise logistic regression was performed to identify factors affecting outcome.
Results: 126 patients were identified; 76 haemorrhage and 50 infarct. Functional improvement was seen in 66.3%, while 26.3% showed an improvement of ≥ 2 points. Patients with haemorrhage performed poorer compared to infarcts (p=0.0152, OR=3.04) and had higher mortality rates (p=0.0734, OR=2.20). Haemorrhage (p=0.0186), male gender (p=0.0077), surgical complications (p=0.0040) and longer hospital stay (p=0.0000058) were associated with mortality. Total (>90%) [p=0.0186] or subtotal (50-90%) [p=0.0149] haematoma evacuation lowered mortality in the haemorrhage subgroup. Age (p=0.0040), GCS< 8 (p=0.0180) and longer hospital stay (p=0.0193) were associated with poor outcomes. Only haematoma size (p=0.0089) was found to influence poor outcomes in the haemorrhage subgroup. Time to surgery from admission did not affect mortality (p=0.2286) or poor outcomes (p=0.724).
Conclusion: Patients with cerebellar haemorrhage who have undergone posterior fossa decompression have poorer outcomes then similar patients with cerebellar infarcts. Factors identified in this study may facilitate future patient selection for surgery. Functional improvement is seen in the majority of patients who survive.
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