Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy
IntroductionDespite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in cerebellar infarction when patients present with neurological deterioration, the precise definition of neurological deterioration remains unclear and accurate timing of SDC can be challenging...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1165258/full |
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| author | Kristin Lucia Sarah Reitz Elke Hattingen Helmuth Steinmetz Volker Seifert Marcus Czabanka |
| author_facet | Kristin Lucia Sarah Reitz Elke Hattingen Helmuth Steinmetz Volker Seifert Marcus Czabanka |
| author_sort | Kristin Lucia |
| collection | DOAJ |
| description | IntroductionDespite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in cerebellar infarction when patients present with neurological deterioration, the precise definition of neurological deterioration remains unclear and accurate timing of SDC can be challenging. The current study aimed at characterizing whether clinical outcomes can be predicted by the GCS score immediately prior to SDC and whether higher GCS scores are associated with better clinical outcomes.MethodsIn a single-center, retrospective analysis of 51 patients treated with SDC for space-occupying cerebellar infarction, clinical and imaging data were evaluated at the time points of symptom onset, hospital admission, and preoperatively. Clinical outcomes were measured by the mRS. Preoperative GCS scores were stratified into three groups (GCS, 3–8, 9–11, and 12–15). Univariate and multivariate Cox regression analyses were performed using clinical and radiological parameters as predictors of clinical outcomes.ResultsIn cox regression analysis GCS scores of 12–15 at surgery were significant predictors of positive clinical outcomes (mRS, 1–2). For GCS scores of 3–8 and 9–11, no significant increase in proportional hazard ratios was observed. Negative clinical outcomes (mRS, 3–6) were associated with infarct volume above 6.0 cm3, tonsillar herniation, brainstem compression, and a preoperative GCS score of 3–8 [HR, 2.386 (CI, 1.160–4.906); p = 0.018].ConclusionOur preliminary findings suggest that SDC should be considered in patients with infarct volumes above 6.0 cm3 and with GCS between 12 and 15, as these patients may show better long-term outcomes than those in whom surgery is delayed until a GCS score below 11. |
| first_indexed | 2024-04-09T17:42:03Z |
| format | Article |
| id | doaj.art-bdeb62da6f884d7fbbc071f145aff8c2 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T17:42:03Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-bdeb62da6f884d7fbbc071f145aff8c22023-04-17T04:52:07ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-04-011410.3389/fneur.2023.11652581165258Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomyKristin Lucia0Sarah Reitz1Elke Hattingen2Helmuth Steinmetz3Volker Seifert4Marcus Czabanka5Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Neurology, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Neuroradiology, University Hospital, Frankfurt, GermanyDepartment of Neurology, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Neurosurgery, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Neurosurgery, University Hospital Frankfurt, Frankfurt, GermanyIntroductionDespite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in cerebellar infarction when patients present with neurological deterioration, the precise definition of neurological deterioration remains unclear and accurate timing of SDC can be challenging. The current study aimed at characterizing whether clinical outcomes can be predicted by the GCS score immediately prior to SDC and whether higher GCS scores are associated with better clinical outcomes.MethodsIn a single-center, retrospective analysis of 51 patients treated with SDC for space-occupying cerebellar infarction, clinical and imaging data were evaluated at the time points of symptom onset, hospital admission, and preoperatively. Clinical outcomes were measured by the mRS. Preoperative GCS scores were stratified into three groups (GCS, 3–8, 9–11, and 12–15). Univariate and multivariate Cox regression analyses were performed using clinical and radiological parameters as predictors of clinical outcomes.ResultsIn cox regression analysis GCS scores of 12–15 at surgery were significant predictors of positive clinical outcomes (mRS, 1–2). For GCS scores of 3–8 and 9–11, no significant increase in proportional hazard ratios was observed. Negative clinical outcomes (mRS, 3–6) were associated with infarct volume above 6.0 cm3, tonsillar herniation, brainstem compression, and a preoperative GCS score of 3–8 [HR, 2.386 (CI, 1.160–4.906); p = 0.018].ConclusionOur preliminary findings suggest that SDC should be considered in patients with infarct volumes above 6.0 cm3 and with GCS between 12 and 15, as these patients may show better long-term outcomes than those in whom surgery is delayed until a GCS score below 11.https://www.frontiersin.org/articles/10.3389/fneur.2023.1165258/fullcerebellarsuboccipital decompressive craniectomyGCSoutcomepredictors |
| spellingShingle | Kristin Lucia Sarah Reitz Elke Hattingen Helmuth Steinmetz Volker Seifert Marcus Czabanka Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy Frontiers in Neurology cerebellar suboccipital decompressive craniectomy GCS outcome predictors |
| title | Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| title_full | Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| title_fullStr | Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| title_full_unstemmed | Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| title_short | Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| title_sort | predictors of clinical outcomes in space occupying cerebellar infarction undergoing suboccipital decompressive craniectomy |
| topic | cerebellar suboccipital decompressive craniectomy GCS outcome predictors |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1165258/full |
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