Preventive Suboccipital Decompressive Craniectomy for Cerebellar Infarction

Abstract

Background and Purpose— No evidence is available on the benefits of preventive suboccipital decompressive craniectomy (SDC) for patients with cerebellar infarction. The purpose of this matched case–control study was to investigate whether preventive SDC was associated with good clinical outcomes in patients with cerebellar infarction and to evaluate its predisposing factors. Methods— Between March 2007 and September 2015, 28 patients underwent preventive SDC. We performed propensity score matching to establish a proper control group among 721 patients with cerebellar infarction during the same period. Group A (n=28) consists of those who underwent preventive SDC, and group B (n=56) consists of those who did not undergo preventive SDC. We analyzed and compared clinical outcomes between groups. Results— Clinical outcomes were better in group A than in group B at discharge ( P =0.048) and 12-month follow-up ( P =0.030). Group B had more deaths within 12 months than group A (log-rank, P <0.05). Logistic regression analysis showed that preventive SDC (odds ratio, 4.815; P =0.009) and the absence of brain stem infarction (odds ratio, 2.862; P =0.033) were independently associated with favorable outcomes (modified Rankin Scale score of 0–2) at 12-month follow-up. Conclusions— Favorable clinical outcomes including overall survival can be expected after preventive SDC in patients with a volume ratio between 0.25 and 0.33 and the absence of brain stem infarction. Among these patients, preventive SDC might be better than the best medical treatment alone.