Predicting Surgical Intervention in Cerebellar Stroke: A Quantitative Retrospective Analysis

• Published in: World neurosurgery 2020-10, Vol.142, p.e160-e172
• Main Authors: Taylor, Douglas R., Basma, Jaafar, Jones, G. Morgan, Lillard, Jock, Wallace, David, Ajmera, Sonia, Gienapp, Andrew J., Michael, L. Madison
• Format: Article
• Language: English
• Subjects: Aged; Brain Edema - etiology; Brain Edema - surgery; Brain Stem - diagnostic imaging; Brain Stem - pathology; Brain Stem Infarctions - etiology; Brain Stem Infarctions - surgery; Cerebellar Diseases - complications; Cerebellar Diseases - surgery; Cerebellar stroke; Cerebellum - diagnostic imaging; Cerebellum - pathology; Clinical Decision Rules; Cohort Studies; Decompression, Surgical - statistics & numerical data; Female; Humans; Hydrocephalus - etiology; Hydrocephalus - surgery; Infarct; Ischemic Stroke - complications; Ischemic Stroke - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Posterior fossa; Retrospective Studies; Risk Assessment; Suboccipital decompression; Tomography, X-Ray Computed; Volumetric analysis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.06.156

Debate still exists regarding whether preventive surgical decompression should be offered to high-risk patients experiencing cerebellar stroke. This study aimed to predict neurologic decline based on risk factors, volumetric analysis, and imaging characteristics. This retrospective cohort study comprised patients ≥18 years who presented with acute cerebellar ischemic stroke (CIS) between January 2011 and December 2016. Diagnostic imaging was used to calculate metrics based on individual stroke, cerebellar, and posterior fossa volumes. Head computed tomography scans on presentation and day of peak swelling were used to tabulate a CIS score. The study included 86 patients; most were male and African American. Posterior inferior communicating artery stroke was most common (50%). On initial presentation imaging, 18.6% had documented hydrocephalus, 20.9% had brainstem compression, 22.1% had brainstem stroke, and 39.5% had stroke in another vascular territory. Cardioembolic stroke was the most common etiology, followed by cryptogenic stroke. Overall, patients who underwent surgical intervention had larger stroke volumes on presentation. Patients undergoing surgical intervention also experienced faster cerebellar swelling compared with patients without intervention. Total CIS scores were statistically significant and remained significant on the peak day of swelling. CIS score was independently associated with neurosurgical intervention; patients in this group with delayed interventions (median CIS score, 6; range, 4–8) later deteriorated and required emergent surgical decompression. Eleven patients without intervention had CIS score >6; 4 patients died of stroke complications. Volumetric studies and CIS score are objective measures that may help predict decline on imaging before clinical deterioration.