Outcomes following Suboccipital Decompressive Craniectomy for Posterior Fossa Stroke with Malignant Cerebellar Oedema: A Case Series and Review of the Literature

Michael Brooks,Ganeshwaran Shivapathasundram,Rebecca Nguyen,Mark Sheridan

doi:10.23937/2643-4474/1710083

Michael Brooks, Ganeshwaran Shivapathasundram + Show 2 more

Open Access

https://doi.org/10.23937/2643-4474/1710083

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Abstract

Suboccipital decompressive craniectomy is a procedure that has been performed to treat malignant cerebellar oedema secondary to posterior fossa strokes. Due to the rarity of the procedure, more evidence is required to better identify factors associated with good or poor outcomes to aid in appropriate patient selection for surgical intervention. Currently known good prognostic factors include reduced time until surgery from deterioration and unilateral infarction.

Highlights

Suboccipital decompressive craniectomy remains a valid procedure for malignant cerebellar oedema secondary to posterior fossa stroke, and further identification of factors which are associated with a good outcome can help with patient selection
Malignant cerebellar oedema occurring secondary to ischaemic strokes of the posterior fossa is a major cause of mortality due to brainstem infarction or mass effect resulting in hydrocephalus, tonsillar herniation, and brainstem compression
We have described the outcomes of seven consecutive patients who underwent suboccipital decompressive craniectomy (SDC) at Liverpool Hospital

Summary

Introduction

Malignant cerebellar oedema occurring secondary to ischaemic strokes of the posterior fossa is a major cause of mortality due to brainstem infarction or mass effect resulting in hydrocephalus, tonsillar herniation, and brainstem compression. Best treatment requires both medical and surgical management. Surgical management includes insertion of external ventricular drain (EVD) with suboccipital decompressive craniectomy (SDC) [1]. Suboccipital decompressive craniectomy is a procedure that has been performed to treat malignant cerebellar oedema secondary to posterior fossa strokes. Due to the rarity of the procedure, more evidence is required to better identify factors associated with good or poor outcomes to aid in appropriate patient selection for surgical intervention. Known good prognostic factors include reduced time until surgery from deterioration and unilateral infarction

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