Craniocervical Junction and Posterior Fossa Dimensions can Affect Need for Decompressive Craniectomy in Posterior Cranial Fossa Hemorrhage

Abstract

Posterior fossa hemorrhage (PFH) of the cerebellum is managed by decompressive craniectomy when there is clinical deterioration. There is no current consensus on an objective imaging method to determine which patients need surgery before clinical deterioration. We developed an imaging scoring tool by assessing initial hemorrhage diameter and posterior fossa (PF) measurements to determine which patients will benefit from early surgical intervention. For this case-control study, we reviewed the electronic medical record to identify adults who presented with PFH over a 10-year period at our institution. Chart review for clinical findings and inciting factors were documented. The average diameter of PFH and the surrogate PF volume on initial imaging studies were measured. These measurements were correlated with surgical intervention. A scoring tool was developed based on radiographic and clinical data. Fifty-one patients met the inclusion criteria. The average hemorrhage diameter and the surrogate PF volume measurements were statistically different between surgical and nonsurgical cases (P < 0.001 and P= 0.019, respectively). The scoring system was created by dividing average hemorrhage diameter by surrogate PF volume and multiplying by 1000. The median score of nonsurgical patients was 9.1, and the median score of surgical patients was 15.6. Patients presenting with PFH with smaller PF volumes may be more likely to require surgery as determined by clinical standards. The proposed scoring system based on simple measurements on initial computed tomography and magnetic resonance imaging may help surgeons consider early surgical intervention in those patients with PFH with smaller PF volumes.