Posterior Fossa Surgery for Stroke: Differences in Outcomes Between Cerebellar Hemorrhage and Infarcts

Abstract

Posterior fossa surgery is the established treatment for large cerebellar strokes with brainstem compression. Despite this, there is a paucity of data for long-term outcomes. A retrospective analysis of patients who underwent posterior fossa surgery for cerebellar hemorrhages and infarcts was performed to compare their difference in 6-month outcomes and to identify factors that affect outcomes. Patients were dichotomized into groups with good outcomes (modified Rankin scale [mRS] score 0-3) or poor outcomes (mRS score 4-6). Sex, age, preoperative Glasgow Coma Scale score, Charleston comorbidity index, time to surgery, intraventricular hemorrhage, surgical complications, length of intensive care unit and hospital stay, shunt dependence, and tracheostomy rates were analyzed. In total, 126 patients were recruited: 76 in hemorrhage group and 50 in infarct group. There was a greater mortality in the hemorrhage group (P= 0.0730). At 6 months, more patients in the hemorrhage group had poor outcomes (P= 0.0074, odds ratio 3.04) and greater mortality (P= 0.0730, odds ratio 2.20). More patients in the hemorrhage group required a tracheostomy (P= 0.0245). Factors predictive of poor outcome include older age (P=0.0108), Glasgow Coma Scale score ≤8 (P= 0.0011), and tracheostomy (P= 0.0269). A total of 69.2% of patients had improvements in mRS scores at 6 months. Shorter length of stay (P= 0.0003) and discharge to a rehabilitation hospital (P= 0.0001) were predictive of functional improvement. Patients who underwent posterior fossa surgery for cerebellar hemorrhage had worse outcomes compared with patients with cerebellar infarcts and were more likely to require a tracheostomy. Rehabilitation helped to improved outcomes.