Türk Nöroşirürji Dergisi 2024 , Vol 34 , Num 1
Factors Affecting Mortality and Functional Outcomes of Suboccipital Decompressive Craniectomy in Posterior Circulation Infarct
Gizem KIPER1,Tuğçe GÖR1,Turan KANDEMIR1
1Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, Eskişehir, Türkiye DOI : 10.5137/1019-5157.TND.3297 AIM: Surgical indication, timing, procedure and patient selection in posterior circulation infarct is controversial. We searched for factors affecting mortality and short-long term functional outcomes of suboccipital decompressive craniectomy (SDC).

MATERIAL and METHODS: Demographic, symptom-history, neurological examination (application, preoperative, discharge and 1-year follow-up Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) score), radiological data, external ventricular drainage, application-neurologic deterioration-surgery intervals, hospitalization duration data of patients with posterior circulation infarct who underwent SDC was collected. Data were analyzed to determine the effect on mortality and long-short term functional outcome. Good outcome was an mRS score of 0-2, bad outcome was mRS 3-6.

RESULTS: Median age was higher (62) in mortal patients than surviving (51) (p=0.04). Median age of good outcome at discharge group was 45, bad outcome was 61 (p=0.004). Median age of good outcome at 1-year follow up group was 46.5, bad outcome was 61 (p=0.01). Median preoperative GCS score of mortality group was 6.5, surviving was 13 (p= 0.04). Preoperative GCS score of good outcome at discharge group was 13, bad outcome was 7.5 (p=0.03). Mortality was associated with hypertension (p=0.007). Neurologic deterioration-surgery time interval was 9.5 hours median at mortality group, 4 hours at survival (p=0.04). 1-year follow up mRS was better than discharge (p=0.026).

CONCLUSION: Prevention and treatment of hypertension reduces mortality. Lower age group is expected to have low mortality with good outcome; should be monitored closely. Surgery should be planned with GCS decrease before a certain low point and soon after neurological deterioration. Long-term outcomes get statistically better with rehabilitation. Anahtar Kelimeler : Suboccipital decompressive craniectomy, Posterior circulation infarct, Malign cerebellar edema, Mortality, Functional outcome