The Tactics of Surgical Treatment in Patients with Cerebellar Infarction
V. G. Dashyan,
Y. A. Khodykin,
A. S. Nikitin,
I. M. Godkov,
D. V. Khovrin,
Y. A. Sosnovsky,
S. A. Asratyan,
A. V. Sytnik,
N. R. Akhmedzhanov https://doi.org/10.23934/2223-9022-2019-8-2-152-159
Abstract
The aim of the study is to specify tactics of surgical treatment of cerebellar infarction (CI).
Material and methods. The results of treatment of 80 patients with CI were studied. According to the clinical course of stroke, the patients were divided into 2 groups. The group of malicious cerebellar infarction included 55 patients (69%) (Group I), the group cerebellar infarction with benign course included 25 patients (31%) (Group II). Patients of Group I were divided into subgroups, in one of them surgical treatment was performed (surgical subgroup), and in the another one, only conservative (conservative subgroup) treatment was performed. In the surgical subgroup, 16 patients underwent isolated ventriculostomy, 5 - posterior fossa decompression (PFD), 18 - combination of ventriculostomy and PFD. The criteria of efficacy of surgery were recovery of consciousness and/or IV ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow Outcome Scale.
Results. Malicious cerebellar infarctions occurred more frequently in patients with volume of ischemia exceeding 20 cm3 in the first day of the disease. The threshold value of mass effect, which may cause further a malocious cerebellar infarction, in the first day of the disease was score 3 according to the M. Jauss scale. In group of patients with malicious cerebellar infarction, surgical treatment reduced the mortality rate of occlusion and dislocation syndrome by 35.8%. The most effective type of intervention was a combination of decompressive trepanation of the posterior cranial fossa and external ventricular drainage. Combined ventriculostomy and PFD were 34 % more effective than just ventriculostomy, and 38 % more effective than just PFD.
Conclusion. Patients with cerebellar infarction of more than 20 cm3 and signs of a mass effect in the posterior cranial fossa score 3 or higher according to M. Jauss scale, are prone to developing a malicious course of the disease. After the development of clinical manifestations of occlusive and dislocation syndrome, they need surgical treatment.
In the surgical treatment of malignant cerebellar infarction, ventriculostomy with PFD are advisable, as each operation separately does not always provide a necessary effect in decompensation of dislocation syndrome.
About the Authors
V. G. Dashyan
A.I. Yevdokimov Moscow State university of Medicine and Dentistry; N.V. Sklifosovsky Research Institute for Emergency Medicine; Tyumen State Medical university of the Ministry
Russian Federation
Russian Federation
Vladimir G. Dashyan - Doctor of Medical Sciences, Professor of the A.I. Yevdokimov MSUMD.
20 building 1, Delegatskaya St., Moscow 127473; 3 Bolshaya Sukharevskaya Square, Moscow 129090; 54 Odesskaya St., Tyumen 625023
Y. A. Khodykin
A.I. Yevdokimov Moscow State university of Medicine and Dentistry; City Clinical Hospital No. 13
Russian Federation
Russian Federation
Yevgeny A. Khodykin - Postgraduate student, Neurosurgeon of the A.I. Yevdokimov MSUMD.
20 building 1, Delegatskaya St., Moscow 127473; 1/1 building 1, Velozavodskaya St., Moscow 115280
A. S. Nikitin
A.I. Yevdokimov Moscow State university of Medicine and Dentistry
Russian Federation
Russian Federation
Andrey S. Nikitin - Candidate of Medical Sciences, Associate Professor, Neurosurgeon of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry
20 building 1, Delegatskaya St., Moscow 127473
I. M. Godkov
N.V. Sklifosovsky Research Institute for Emergency Medicine
Russian Federation
Russian Federation
Ivan M. Godkov - Candidate of Medical Sciences, Senior Researcher.
3 Bolshaya Sukharevskaya Square, Moscow 129090
D. V. Khovrin
S.S. Yudin City Clinical hospital
Russian Federation
Russian Federation
Dmitry V. Khovrin - Head of the Neurosurgical Department.
3 Academika Millionshchikova St., Moscow 115516
Y. A. Sosnovsky
V.V. Veresayev City Clinical hospital
Russian Federation
Russian Federation
Yevgeny A. Sosnovsky - Candidate of Medical Sciences, Head of the Neurosurgical Department.
10 Lobnenskaya St., Moscow 127644
S. A. Asratyan
V.M. Buyanov City Clinical hospital
Russian Federation
Russian Federation
Sarkis A. Asratyan - Candidate of Medical Sciences, Head of the Neurosurgical Department.
26 Bakinskaya St., Moscow 115516
A. V. Sytnik
City Clinical Hospital No. 13
Russian Federation
Russian Federation
Aleksey V Sytnik - Head of the Neurosurgical Department.
1/1 building 1, Velozavodskaya St., Moscow 115280
N. R. Akhmedzhanov
City Clinical Hospital No. 13; V.V. Veresayev City Clinical hospital
Russian Federation
Russian Federation
Nailya R. Akhmedzhanova - Radiologist, V.V. Veresayev CCH.
1/1 building 1, Velozavodskaya St., Moscow 115280; 10 Lobnenskaya St., Moscow 127644
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Review
For citations:
Dashyan V.G., Khodykin Y.A., Nikitin A.S., Godkov I.M., Khovrin D.V., Sosnovsky Y.A., Asratyan S.A., Sytnik A.V., Akhmedzhanov N.R. The Tactics of Surgical Treatment in Patients with Cerebellar Infarction. Russian Sklifosovsky Journal "Emergency Medical Care". 2019;8(2):152-159. https://doi.org/10.23934/2223-9022-2019-8-2-152-159
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