Suboccipital Decompressive Necrosectomy After Cerebellar Stroke with Good Clinical Outcome

Large cerebellar infarcts are rare, but their mortality is significantly higher than that of anterior circulation strokes. Decompressive craniectomy (DC) and necrosectomy (DN) are potentially lifesaving neurosurgical procedures to reduce intracranial pressure and prevent brain herniation due to cerebral swelling or intracranial hemorrhage. In the adult population, there is strong evidence that DC reduces mortality and morbidity after major stroke with associated ischemic brain swelling. There is also evidence for the benefit of suboccipital decompressive craniectomy (SDC) in space-occupying cerebellar stroke (SOCS), but the optimal surgical approach in the posterior fossa remains controversial. An alternative to craniectomy is craniotomy with necrosectomy followed by reimplantation of the bone flap. In this chapter, we describe the clinical course of a 37-year-old male patient with vertebral artery/V3 dissection who suffered from distal vertebral artery and posterior inferior cerebellar artery occlusion and subsequent cerebellar stroke. After neurological deterioration due to swelling of the ischemic cerebellar tissue, he underwent suboccipital craniotomy and necrosectomy and recovered shortly thereafter. Suboccipital craniotomy and necrosectomy as an emergency neurosurgical treatment for space-occupying cerebellar stroke is the subject of this chapter.