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Dash'jan V.G.

GBOU VPO «MGMSU im. A.I. Evdokimova» Minzdrava Rossii, Moskva;
GBUZ «NII skoroj pomoschi im. N.V. Sklifosovskogo» Departamenta zdravoohranenija Moskvy, Moskva

Khodykin E.A.

Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
Moscow City Clinical Hospital #13, Moscow, Russia

Nikitin A.S.

Gorodskaia klinicheskaia bol'nitsa #12, Moskva

Godkov I.M.

Research Institute of emergency medicine named after N.V. Sklifosofskiy, Moscow

Khovrin D.V.

Yudin Moscow City Clinical Hospital, Moscow, Russia

Sosnovskiy E.A.

Veresaev City Clinical Hospital, Moscow, Russia

Asratian S.A.

Gorodskaia klinicheskaia bol'nitsa #12 Departamenta zdravookhraneniia Moskvy

Sytnik A.V.

GBOU VPO «MGMSU im. A.I. Evdokimova» Minzdrava Rossii, Moskva;
GBUZ «NII skoroj pomoschi im. N.V. Sklifosovskogo» Departamenta zdravoohranenija Moskvy, Moskva

Ochkin S.S.

City Clinical Hospital №13, Moscow, Russia

Akhmedzhanova N.R.

Veresaev Moscow City Clinical Hospital, Moscow, Russia;
Moscow City Clinical Hospital #13, Moscow, Russia

Malignant cerebellar infarction: clinical course and surgical treatment

Authors:

Dash'jan V.G., Khodykin E.A., Nikitin A.S., Godkov I.M., Khovrin D.V., Sosnovskiy E.A., Asratian S.A., Sytnik A.V., Ochkin S.S., Akhmedzhanova N.R.

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Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(8‑2): 75‑83

DOI: 10.17116/jnevro201911908275

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To cite this article:

Dash'jan VG, Khodykin EA, Nikitin AS, et al. . Malignant cerebellar infarction: clinical course and surgical treatment. S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(8‑2):75‑83. (In Russ.)
https://doi.org/10.17116/jnevro201911908275

 
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Objective. To clarify the indications for surgical treatment of malignant cerebellar infarction (CI). Material and methods. Eighty patients with CI were studied. The malignancy of CI was understood as the development of mass effect in the posterior cranial fossa, accompanied by the decrease in consciousness due to compression of the brain stem and/or the development of occlusive hydrocephalus. The patients were divided into 2 groups. The group of malignant CI included 55 patients (68.75%) (group I), the group of benign CI included 25 patients (31.25%) (group II). Patients of group I were divided into subgroups, one of them underwent surgical treatment (surgical subgroup), and another only conservative (conservative subgroup) treatment. Surgery efficacy criteria were: restoration of consciousness to 15 points according to GCS and/or restoration of the fourth ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow outcome scale. Results. Malignant CI occurred more frequently in patients with the volume of ischemia exceeding 20 cm3 (p<0.05) in the first day of the disease. The threshold value of mass effect, which can cause further a malignant CI, was 3 points according to the M. Jauss scale. In the group of patients with malignant CI, surgical treatment reduced the mortality rate from 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. Conclusion. In patients with CI with the volume more than 20 cm3 and signs of mass effect in the posterior cranial fossa on the scale of M. Jauss 3 points or more, the malignant course of the disease develops in 67% of cases. These patients require careful monitoring, and, in case of development of malignant CI, surgical treatment is necessary.

Keywords:

cerebellar infarction
occlusive hydrocephalus
brain stem compression
surgical treatment
decompressive trepanation
CSF bypass

Authors:

Dash'jan V.G.

GBOU VPO «MGMSU im. A.I. Evdokimova» Minzdrava Rossii, Moskva;
GBUZ «NII skoroj pomoschi im. N.V. Sklifosovskogo» Departamenta zdravoohranenija Moskvy, Moskva

Khodykin E.A.

Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
Moscow City Clinical Hospital #13, Moscow, Russia

Nikitin A.S.

Gorodskaia klinicheskaia bol'nitsa #12, Moskva

Godkov I.M.

Research Institute of emergency medicine named after N.V. Sklifosofskiy, Moscow

Khovrin D.V.

Yudin Moscow City Clinical Hospital, Moscow, Russia

Sosnovskiy E.A.

Veresaev City Clinical Hospital, Moscow, Russia

Asratian S.A.

Gorodskaia klinicheskaia bol'nitsa #12 Departamenta zdravookhraneniia Moskvy

Sytnik A.V.

GBOU VPO «MGMSU im. A.I. Evdokimova» Minzdrava Rossii, Moskva;
GBUZ «NII skoroj pomoschi im. N.V. Sklifosovskogo» Departamenta zdravoohranenija Moskvy, Moskva

Ochkin S.S.

City Clinical Hospital №13, Moscow, Russia

Akhmedzhanova N.R.

Veresaev Moscow City Clinical Hospital, Moscow, Russia;
Moscow City Clinical Hospital #13, Moscow, Russia

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