Functional and mortality outcomes with medical and surgical therapy in malignant posterior circulation infarcts: A systematic review

Abstract

Abstract Background There remains uncertainty regarding optimal definitive management for malignant posterior circulation infarcts (MPCI). While guidelines recommend neurosurgery for malignant cerebellar infarcts that are refractory to medical therapy, concerns exist about functional outcome and quality of life after decompressive surgery. Objective This study aims to evaluate the outcomes of surgical intervention compared to medical therapy in MPCI. Methods In this systematic review, MEDLINE, Embase and Cochrane databases were searched from inception until 2nd April 2021. Studies were included if they involved posterior circulation strokes treated with neurosurgical intervention, and reported mortality and functional outcome data. Data were collected according to PRISMA guidelines. Results The search yielded 6,677 studies of which 31 studies (comprising 723 patients) were included for analysis. From the included studies, we found that surgical therapy led to significant differences in mortality and functional outcomes in patients with severe disease. Neurological decline and radiological criteria was often used to decide the timing for surgical intervention, as there is currently limited evidence for preventative neurosurgery. There is also limited evidence for the superiority of one surgical modality over another. Conclusion For patients with MPCI, in terms of mortality and functional outcome, surgical therapy appears to be equivocal to medical therapy, except in patients with severe disease. Reliable evidence is lacking and further prospective studies are rendered.