Surgical treatment not better than Conservative Management for Cerebellar Infarcts, suggests study

In a recent study published in the Journal of the American Medical Association highlight the debate surrounding the optimal management of cerebellar infarcts. The study was conducted across multiple medical centers in Germany between 2008 and 2021 to compare the functional outcomes of surgical intervention versus conservative management in patients with cerebellar infarcts.

Cerebellar infarcts are characterized by severe cerebellar swelling and often pose challenge for healthcare professionals due to the lack of a universal definition for swelling and infarct volumes to guide treatment decisions. According to the current guidelines from the American Heart Association/American Stroke Association, decompressive surgery is recommended for patients with severe cerebellar swelling, but the evidence supporting this approach has been limited.

The retrospective multicenter cohort study included a total of 531 patients with cerebellar infarcts by analyzing data up to November 2023. The team led by Sae-Yeon Won compared outcomes between patients who underwent surgical treatment, namely posterior fossa decompression along with standard care, and those managed conservatively with medical treatment alone.

The study found that overall there was no significant difference in favorable outcomes between patients treated surgically and the patients managed conservatively, both at discharge and at the one-year follow-up. Distinct patterns emerged when the analysis was stratified based on the size of the infarct volume.

The patients with larger cerebellar infarct volumes (35 mL or greater) experienced significantly better outcomes with surgical intervention at the one-year follow-up. Also, the conservative management seemed more beneficial for patients with smaller infarct volumes (less than 25 mL). While surgery may offer advantages for patients with larger infarcts, the conservative management appears to be an reasonable option for the individuals with smaller infarcts by highlighting the need for further research and refined guidelines.

Reference:

Won, S.-Y., Hernández-Durán, S., Behmanesh, B., Bernstock, J. D., Czabanka, M., Dinc, N., Dubinski, D., Freiman, T. M., Günther, A., Hellmuth, K., Herrmann, E., Konczalla, J., Maier, I., Melkonian, R., Mielke, D., Naser, P., Rohde, V., Senft, C., Storch, A., … Gessler, F. (2024). Functional Outcomes in Conservatively vs Surgically Treated Cerebellar Infarcts. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2023.5773