Preventive Suboccipital Decompressive Craniectomy for Cerebellar Infarction

Patients with cerebellar infarction should not be neglected because they can experience sudden clinical deterioration from cerebellar swelling. Compared with malignant middle cerebral artery infarctions, malignant cerebellar infarctions can be more urgent because of the smaller space of the posterior fossa, consecutive brain stem compression, and obstructive hydrocephalus. In these situations, suboccipital decompressive craniectomy (SDC) is recommended as a lifesaving therapy although no randomized controlled trials on this therapy have been conducted. Furthermore, no evidence is available on the benefits of preventive SDC for patients with cerebellar infarction, whereas the benefits of early preventive decompressive hemicraniectomy for malignant middle cerebral artery infarction are supported by randomized controlled trials. However, a subset of patients might be expected to benefit in terms of improved survival and functional outcomes from preventive SDC. Determining how to select patients who are good candidates for preventive SDC would be useful. Thus, the purpose of this matched case–control study was to investigate whether preventive SDC was associated with good clinical outcome in patients with cerebellar infarction and to evaluate its predisposing factors.