– Space-occupying cerebellar ischemic strokes (SOCS) often lead to neurological deterioration and require surgical intervention to release pressure from the posterior fossa. Current guidelines recommend suboccipital decompressive craniectomy (SDC) with dural expansion when medical therapy is not sufficient. However, there is no good-quality evidence to support this surgical practice, and both surgical timing and technique remain controverted. In this study, we describe an alternative to SDC, namely surgical evacuation of infarcted tissue (necrosectomy) and its clinical outcomes.
– In this retrospective, single-center study, 34 consecutive patients with SOCS undergoing necrosectomy via osteoplastic craniotomy were included. Patient characteristics and radiological findings were evaluated. In order to differentiate the effects of age on the functional outcome, patients were divided into two groups (group I: age ≤60; group II: age >60). Functional outcome was assessed using the Glasgow outcome scale (GOS), modified Rankin scale (mRS) and Barthel index (BI) at the time of discharge and 30 days postoperatively.
– In our cohort, we observed a 21% overall mortality, while 76% of patients reached good functional outcome (GOS≥4). No statistically significant differences in mortality or functional outcome were observed between both patient groups. Comparing our data to a recent meta-analysis on SDC, the number of adverse events and unfavorable outcome showed equipoise between both treatment modalities.
– Necrosectomy appears to be a suitable alternative to SDC in SOCS, achieving comparable mortality and functional outcomes. Further trials are necessary to evaluate which surgical technique is more beneficial in the setting of SOCS.

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