ImportanceAccording to the current American Heart Association/American Stroke Association guidelines, decompressive surgery is indicated in patients with cerebellar infarcts that demonstrate severe cerebellar swelling. However, there is no universal definition of swelling and/or infarct volume(s) available to support a decision for surgery.ObjectiveTo evaluate functional outcomes in surgically compared with conservatively managed patients with cerebellar infarcts.Design, Setting, and ParticipantsIn this retrospective multicenter cohort study, patients with cerebellar infarcts treated at 5 tertiary referral hospitals or stroke centers within Germany between 2008 and 2021 were included. Data were analyzed from November 2020 to November 2023.ExposuresSurgical treatment (ie, posterior fossa decompression plus standard of care) vs conservative management (ie, medical standard of care).Main Outcomes and MeasuresThe primary outcome examined was functional status evaluated by the modified Rankin Scale (mRS) at discharge and 1-year follow-up. Secondary outcomes included the predicted probabilities for favorable outcome (mRS score of 0 to 3) stratified by infarct volumes or Glasgow Coma Scale score at admission and treatment modality. Analyses included propensity score matching, with adjustments for age, sex, Glasgow Coma Scale score at admission, brainstem involvement, and infarct volume.ResultsOf 531 included patients with cerebellar infarcts, 301 (57%) were male, and the mean (SD) age was 68 (14.4) years. After propensity score matching, a total of 71 patients received surgical treatment and 71 patients conservative treatment. There was no significant difference in favorable outcomes (ie, mRS score of 0 to 3) at discharge for those treated surgically vs conservatively (47 [66%] vs 45 [65%]; odds ratio, 1.1; 95% CI, 0.5-2.2; P > .99) or at follow-up (35 [73%] vs 33 [61%]; odds ratio, 1.8; 95% CI, 0.7-4.2; P > .99). In patients with cerebellar infarct volumes of 35 mL or greater, surgical treatment was associated with a significant improvement in favorable outcomes at 1-year follow-up (38 [61%] vs 3 [25%]; odds ratio, 4.8; 95% CI, 1.2-19.3; P = .03), while conservative treatment was associated with favorable outcomes at 1-year follow-up in patients with infarct volumes of less than 25 mL (2 [34%] vs 218 [74%]; odds ratio, 0.2; 95% CI, 0-1.0; P = .047).Conclusions and RelevanceOverall, surgery was not associated with improved outcomes compared with conservative management in patients with cerebellar infarcts. However, when stratifying based on infarct volume, surgical treatment appeared to be beneficial in patients with larger infarct volumes, while conservative management appeared favorable in patients with smaller infarct volumes.

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保守治疗与手术治疗小脑梗塞的功能结果

重要性根据当前的美国心脏协会/美国中风协会指南，对于表现出严重小脑肿胀的小脑梗塞患者需要进行减压手术。然而，目前还没有肿胀和/或梗塞体积的通用定义来支持手术决策。目的与保守治疗的小脑梗塞患者相比，评估手术后的功能结果。设计、设置和参与者在这个回顾性多中心队列中研究纳入了 2008 年至 2021 年间在德国境内 5 家三级转诊医院或卒中中心接受治疗的小脑梗塞患者。数据分析时间为 2020 年 11 月至 2023 年 11 月。暴露手术治疗（即后颅窝减压加标准护理）与保守治疗（即医疗标准护理）。主要结果和措施检查的主要结果是通过改良 Rankin 评估的功能状态出院时和 1 年随访时的量表 (mRS)。次要结局包括按入院时的梗死体积或格拉斯哥昏迷量表评分和治疗方式分层的有利结果（mRS 评分为 0 至 3）的预测概率。分析包括倾向评分匹配，并根据年龄、性别、入院时格拉斯哥昏迷量表评分、脑干受累情况和梗塞体积进行调整。结果 531 名小脑梗塞患者中，301 名 (57%) 为男性，平均 (SD) 年龄68（14.4）岁。经过倾向评分匹配，共有71名患者接受了手术治疗，71名患者接受了保守治疗。手术治疗与保守治疗的患者出院时的良好结局（即 mRS 评分为 0 至 3）没有显着差异（47 [66%] vs 45 [65%]；比值比，1.1；95% CI，0.5- 2.2；磷> .99）或随访时（35 [73%] vs 33 [61%]；比值比，1.8；95% CI，0.7-4.2；磷> .99）。在小脑梗塞体积为 35 mL 或更大的患者中，手术治疗与 1 年随访时良好结局的显着改善相关（38 [61%] vs 3 [25%]；比值比，4.8；95% CI，1.2-19.3；磷= .03），而对于梗死体积小于 25 mL 的患者，保守治疗与 1 年随访时的良好结果相关（2 [34%] vs 218 [74%]；比值比，0.2；95%置信区间，0-1.0；磷= .047）。结论和相关性总体而言，与小脑梗塞患者的保守治疗相比，手术与结果改善无关。然而，当根据梗塞体积进行分层时，手术治疗似乎对梗塞体积较大的患者有益，而保守治疗似乎对梗塞体积较小的患者有利。