Outcomes of patients with posterior fossa stroke admitted to the ICU : an observational retrospective cohort

Position du problème et objectif(s) de l’étude

Posterior fossa strokes present specific challenges in management and prognosis due to limited intracranial space and high risk of brainstem compression. Many patients require intensive care unit (ICU) admission, and some undergo surgical interventions, such as suboccipital decompressive craniectomy (SDC). This study aimed at describing the clinical characteristics, management strategies, and outcomes of patients admitted to ICU for posterior fossa strokes.

Matériel et méthodes

We conducted a retrospective, single-center, study that included all adult patients admitted to the neuro-ICU of a tertiary hospital between 2016 and 2021 for a cerebellar stroke, ischaemic or haemorrhagic. Patients with tumor-related, traumatic, or infectious lesions were excluded. Clinical characteristics, imaging findings, and treatment strategies were collected from medical records. The primary outcome was functional status at one year assessed using the modified Rankin Scale (mRS), with a good outcome defined as a mRS ≤ 2. Secondary outcomes included ICU and one-year mortality. Univariable and multivariable analyses were performed to identify factors associated with surgical intervention and long-term prognosis.

Résultats & Discussion

A total of 53 patients were included, with a median age of 57 years old and 55% male prevalence. On admission, the median Glasgow Coma Scale (GCS) was 14 [IQR 9-15], and 30% of patients experienced clinical deterioration within 48 hours. The median lesion volume was 41.5 cm³ [IQR 13.5-72.5], with 64% of patients presenting signs of posterior fossa hypertension (fourth ventricle compression, quadrigeminal cistern compression, or tonsillar herniation) and 62% developing hydrocephalus. SDC was performed in 49% of patients (n=26), and 49.1% (n=26) required external ventricular drainage (EVD). Patients undergoing SDC had significantly lower GCS on admission (70% with GCS < 13 vs. 34% in the non-surgical group p=0.025), larger stroke volumes (57 cm³ vs. 18 cm³, p<0.001), and more frequent signs of brainstem compression (88% vs. 41%, p<0.001). ICU mortality was 23% (n=12), and one-year mortality reached 32% (n=17). At one year, 41.5% of patients achieved a good functional outcome (mRS ≤ 2). However, there was no significant difference in functional outcome between those who underwent SDC (42%) and those who did not (41%, p=0.777). Factors associated with better prognosis included younger age (under 50 years old), higher initial GCS and absence of brainstem compression. Stroke etiology (ischemic vs. hemorrhagic) did not significantly impact long-term outcome.

Conclusion

Patients admitted to ICU for posterior fossa strokes have poor long-term functional outcome, with high mortality and limited recovery after ICU discharge. SDC did not demonstrate a clear benefit in functional recovery but was more frequently performed in patients with larger strokes and lower consciousness levels. Given the lack of strong evidence supporting surgical intervention, future prospective randomized trials are needed to better define the role of SDC in this population.

Auteurs

Salomé SMADJA - (1)Lariboisière, Paris, France

Orateur(s)

Salomé SMADJA (Paris)