Introduction: Cerebellar ischemic stroke and hemorrhage are causes of morbidity in the aging population. Guidelines from the American Stroke Association recommend emergent decompression in patients who have brainstem compression, hydrocephalus or clinical deterioration. The authors sought to determine the 30 day and 1 year mortality rates in patients >60 years of age undergoing emergent posterior fossa decompression.
Methods: Surgical records were to identify all patients >60 years of age who underwent an emergent posterior fossa decompressive surgery. Mortality rates were calculated at 30 days and 1 year post-operatively, and these rates were compared to patient and procedure characteristics, including age, volume of infarct/bleed, size of craniectomy and side of pathology.
Results: There were 34 emergent posterior fossa decompressions on patients >60 years of age between 2000-2014. There were 7/34 (21%) patients aged 60-69, 12/34 (35%) 70-79, and 15/34 (44%) patients aged 80 or greater. All cause mortality rates at 30 days were 0%, 33% and 25% for age deciles 60-69, 70-79 and 80+. Increasing age (Alive at 30 days – 75.2 +/- 1.7 years vs. Deceased – 81.1 +/- 1.7 years, p=0.01) and smaller craniectomy dimensions were associated with 30 day mortality (alive at 30 days – 17.7 +/-1.5 cm2 vs. deceased – 13.1 +/- 0.9 cm2, p=0.01). Mortality rates at 1 year were 0%, 50% and 67% for age deciles 60-69, 70-79 and 80+. Increasing age was significantly associated with mortality at 1 year (Alive at 1 year – 72.3 +/- 2.0 years vs. Deceased – 81.1 +/- 1.2 years, p<0.01). Craniectomy size was not significantly associated with mortality at 1 year. Type of pathology, side of pathology, volume and placement of an EVD were not associated with mortality.
Conclusions: Increasing age and smaller craniectomy size are significantly associated with increased mortality rates in patients undergoing emergent posterior fossa decompressive surgery.
Patient Care: This project will help surgeons understand and counsel family members regarding mortality rates after emergent posterior fossa decompression for hemorrhage or infarct. It also demonstrates that for patients going to surgery, larger craniectomy size is associated with decreased mortality rates
Learning Objectives: -All cause mortality rates at 30 days were 0%, 33% and 25% for age deciles 60-69, 70-79 and 80+.
-Mortality rates at 1 year were 0%, 50% and 67% for age deciles 60-69, 70-79 and 80+.
-Increasing age and smaller craniectomy were associated with higher mortality rates