Size of Decompressive Craniectomy as Prognostic Factor in Space-Occupying Ischemic Cerebellar Stroke - A Multicentric Retrospective Study

Sep 29, 2026

Uploaded by Liam

Space-occupying ischemic cerebellar strokes are managed with suboccipital decompressive surgery (SDC) recommended by guidelines, yet the optimal size of the removed bone flap for SDC remains unclear. This multicentric retrospective study measured SDC dimensions on early postoperative CT in two planes and evaluated functional outcome using the modified Rankin Scale at three months. In 88 patients, larger lateral extension (L ≥ 6.5 cm) correlated with improved functional outcomes, while three-month mortality showed no significant difference. Complications were also assessed, and findings support the need for prospective confirmation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Research Question

Methods

Results

Conclusions

Brain and Spine 6 (2026) 105911 Contents lists available at ScienceDirect Brain and Spine journal [homepage:](homepage: www.journals.elsevier.com/brain-and-spine)[ www.journals.elsevier.com/brain-and-spine](homepage: www.journals.elsevier.com/brain-and-spine) Size of decompressive craniectomy as prognostic factor in space-occupying ischemic cerebellar stroke –a multicentric retrospective study Silvia Hern´andez-Dur´an a,c,* , Johannes Walter b,1, Daniel Dubinskia , Obada T. Alhalabib , Milos Arsenovica, Daniel Cantred , Nazife Dince, Judith Dremelf, Nima Etminanf, Thomas M. Freiman c, Kiarash Ferdowssiang , Erdem Güresir h , Katharina A.M. Hackenberg f, Motaz Hamedi, Andreas Kramer j, Christopher Kr¨amer g, Beate Kranawetter c , Tim Lampmanni , Anne Neumeister e, Artem Rafaeliana , Florian Ringel j, Veit Rohdec, Jan Hendrik Sch¨aferk, Michael Schwakel , Christian Senfte, Alexander Storch m, Moritz Thiell, Merih Turgutj, Andreas W. Unterbergb, Peter Vajkoczy g, Hartmut Vatteri, Martin Vychopenh, Johannes Wachh , Matthias Wittstock m, Florian Gesslera,2 , Sae-Yeon Won a,2 a Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany b Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany and University of Heidelberg, Medical Faculty, Heidelberg, Germany c Department of Neurosurgery, University Hospital G¨ottingen, G¨ottingen, Germany d Department of Neuroradiology, University Medical Center Rostock, Rostock, Germany e Department of Neurosurgery, University Hospital Jena, Jena, Germany f Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany g Department of Neurosurgery, Charit´e – Universit¨atsmedizin Berlin, corporate member of Freie Universit¨at Berlin, Humboldt-Universit¨at zu Berlin, and Berlin Institute of Health, Berlin, Germany h Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany i Department of Neurosurgery, University Hospital Bonn, Bonn, Germany j Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany k Goethe University Frankfurt, University Hospital, Department of Neurology, Frankfurt am Main, Germany l Department of Neurosurgery, University Hospital Münster, Münster, Germany m Department of Neurology, University Medical Center Rostock, Rostock, Germany A R T I C L E I N F O Keywords: Cerebellar stroke Suboccipital craniectomy Surgery for stroke A B S T R A C T Introduction: In cases of space-occupying cerebellar ischemic strokes, guidelines recommend suboccipital decompressive surgery (SDC). While in supratentorial hemispheric stroke, the size of the bone flap has been the subject of many studies and ample debate, no studies have been conducted to determine the optimal size of the bone flap to be removed in SDC. Research question: To determine the optimal size of SDC in ischemic cerebellar stroke. Methods: This is a multicentric retrospective study of patients undergoing SDC for ischemic cerebellar stroke. SDC size was determined in two perpendicular planes on early postoperative CT scans: (a) maximal lateral extension (L) and (b) maximal craniocaudal extension (CC) in cm. The primary endpoint was functional outcome according to modified Rankin Scale (mRS) at three months. Secondary outcome was mortality at three months, as well as surgical complications. Results: A total of 88 patients were included in the final analysis. The mean L diameter of the SDC analyzed was 7 cm (SD 1.5), whereas the mean CC diameter was 4.4 cm (SD .8). When dichotomizing patients based on a threshold of L ≥ 6.5 cm, favorable outcome was more likely in the group with L ≥ 6.5 cm (OR = 3.23, 95%CI 1.02–10.56, p = .045). No statistically significant differences were observed in mortality at three months (OR =.66, 95%CI .24–1.78, p = .40). * Corresponding author. Department of Neurosurgery, University Medical Center Rostock Schillingallee 35, 18057, R

FAQs

What clinical problem does the study address?

The study addresses the lack of evidence on the optimal size of the bone flap removed during suboccipital decompressive surgery (SDC) for space-occupying ischemic cerebellar stroke.

How was SDC size measured and what endpoint was used?

SDC size was measured on early postoperative CT in two perpendicular planes: maximal lateral extension (L) and maximal craniocaudal extension (CC). Functional outcome at three months was assessed using the modified Rankin Scale (mRS).

What did the study find about SDC size and outcomes?

When patients were dichotomized using a threshold of L ≥ 6.5 cm, favorable functional outcome was more likely in the larger L group. Three-month mortality did not differ significantly between groups.

Sep 29, 2026

Uploaded by Liam