Abstract：
OBJECTIVE: Space-occupying cerebellar stroke (SOCS) when coupled with neurological deterioration represents a neurosurgical emergency. Although current evidence supports surgical intervention in such patients with SOCS and rapid neurological deterioration, the optimal surgical methods/techniques to be applied remain a matter of debate.
METHODS: We conducted a retrospective, multicenter study of patients undergoing surgery for SOCS. Patients were stratified according to the type of surgery as (1) suboccipital decompressive craniectomy (SDC) or (2) suboccipital craniotomy with concurrent necrosectomy. The primary end point examined was functional outcome using the modified Rankin Scale (mRS) at discharge and at 3 months (mRS 0-3 defined as favorable and mRS 4-6 as unfavorable outcome). Secondary end points included the analysis of in-house postoperative complications, mortality, and length of hospitalization.
RESULTS: Ninety-two patients were included in the final analysis: 49 underwent necrosectomy and 43 underwent SDC. Those with necrosectomy displayed significantly higher rate of favorable outcome at discharge as compared with those who underwent SDC alone: 65.3% vs 27.9%, respectively ( P < .001, odds ratios 4.9, 95% CI 2.0-11.8). This difference was also observed at 3 months: 65.3% vs 41.7% ( P = .030, odds ratios 2.7, 95% CI 1.1-6.7). No significant differences were observed in mortality and/or postoperative complications, such as hemorrhagic transformation, infection, and/or the development of cerebrospinal fluid leaks/fistulas.
CONCLUSIONS: In the setting of SOCS, patients treated with necrosectomy displayed better functional outcomes than those patients who underwent SDC alone. Ultimately, prospective, randomized studies will be needed to confirm this finding.
METHODS: We conducted a retrospective, multicenter study of patients undergoing surgery for SOCS. Patients were stratified according to the type of surgery as (1) suboccipital decompressive craniectomy (SDC) or (2) suboccipital craniotomy with concurrent necrosectomy. The primary end point examined was functional outcome using the modified Rankin Scale (mRS) at discharge and at 3 months (mRS 0-3 defined as favorable and mRS 4-6 as unfavorable outcome). Secondary end points included the analysis of in-house postoperative complications, mortality, and length of hospitalization.
RESULTS: Ninety-two patients were included in the final analysis: 49 underwent necrosectomy and 43 underwent SDC. Those with necrosectomy displayed significantly higher rate of favorable outcome at discharge as compared with those who underwent SDC alone: 65.3% vs 27.9%, respectively ( P < .001, odds ratios 4.9, 95% CI 2.0-11.8). This difference was also observed at 3 months: 65.3% vs 41.7% ( P = .030, odds ratios 2.7, 95% CI 1.1-6.7). No significant differences were observed in mortality and/or postoperative complications, such as hemorrhagic transformation, infection, and/or the development of cerebrospinal fluid leaks/fistulas.
CONCLUSIONS: In the setting of SOCS, patients treated with necrosectomy displayed better functional outcomes than those patients who underwent SDC alone. Ultimately, prospective, randomized studies will be needed to confirm this finding.
摘要：
目的：占位性小脑卒中（SOCS）与神经系统恶化一起代表神经外科急症。尽管目前的证据支持对这类患有SOCS和神经系统快速恶化的患者进行手术干预，要应用的最佳手术方法/技术仍存在争议。
方法：我们进行了回顾性研究，接受SOCS手术患者的多中心研究。根据手术类型将患者分层为（1）枕下去骨瓣减压术（SDC）或（2）枕下开颅术并同时进行坏死切除术。检查的主要终点是出院时和3个月时使用改良的Rankin量表（mRS）的功能结局（mRS0-3定义为有利结局，mRS4-6定义为不利结局）。次要终点包括内部术后并发症的分析,死亡率,和住院时间。
结果：最终分析包括92例患者：49例接受了坏死切除术，43例接受了SDC。与单纯接受SDC的患者相比，接受坏死切除术的患者在出院时表现出更高的良好结局率：65.3％vs27.9％，分别（P<.001，比值比4.9，95%CI2.0-11.8）。在3个月时也观察到了这种差异：65.3%对41.7%（P=0.030，比值比2.7，95%CI1.1-6.7）。在死亡率和/或术后并发症方面没有观察到显著差异。比如出血性转化，感染,和/或脑脊液漏/瘘的发展。
结论：在SOCS的设置中，接受坏死切除术治疗的患者比单纯接受SDC治疗的患者表现出更好的功能结局.最终,prospective,需要随机研究来证实这一发现.
方法：我们进行了回顾性研究，接受SOCS手术患者的多中心研究。根据手术类型将患者分层为（1）枕下去骨瓣减压术（SDC）或（2）枕下开颅术并同时进行坏死切除术。检查的主要终点是出院时和3个月时使用改良的Rankin量表（mRS）的功能结局（mRS0-3定义为有利结局，mRS4-6定义为不利结局）。次要终点包括内部术后并发症的分析,死亡率,和住院时间。
结果：最终分析包括92例患者：49例接受了坏死切除术，43例接受了SDC。与单纯接受SDC的患者相比，接受坏死切除术的患者在出院时表现出更高的良好结局率：65.3％vs27.9％，分别（P<.001，比值比4.9，95%CI2.0-11.8）。在3个月时也观察到了这种差异：65.3%对41.7%（P=0.030，比值比2.7，95%CI1.1-6.7）。在死亡率和/或术后并发症方面没有观察到显著差异。比如出血性转化，感染,和/或脑脊液漏/瘘的发展。
结论：在SOCS的设置中，接受坏死切除术治疗的患者比单纯接受SDC治疗的患者表现出更好的功能结局.最终,prospective,需要随机研究来证实这一发现.
