{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:35:41Z","timestamp":1791434141571,"version":"4.3.3"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nRecent work on ischemic cerebellar stroke has suggested that the resection of infarcted tissue may lead to improved functional outcomes compared with decompressive surgery alone. Nonetheless, no studies have assessed the extent to which necrotic tissue should be resected or if there are any volumetric thresholds capable of predicting functional outcomes in this patient population. In this study, the authors aimed to determine potential thresholds for volume reduction in ischemic cerebellar stroke in an effort to optimize the management of ischemic cerebellar stroke and, in so doing, improve functional outcomes.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nThis study is a multicentric retrospective study of patients who underwent surgery for the management of ischemic cerebellar stroke. Volumetric analyses of infarcted tissue present on CT scans were performed before and after surgical intervention(s). The final infarct volume (FIV) was computed as a percentage of the initial infarct volume (postoperative infarct volume\/preoperative infarct volume \u00d7 100). The primary endpoint was functional outcome at 3 months, as determined by the modified Rankin Scale (mRS) score; mRS scores 0\u20132 were considered as favorable and mRS scores 3\u20136 as unfavorable. Receiver operating characteristic curves were used to explore the relationship between postoperative infarct volumes and FIV versus mRS score, and Youden\u2019s index was used to estimate potential volumetric thresholds.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nA total of 91 patients were included in the study. The mean pre- and postoperative infarct volumes were 45.25 (SD 18.32) cm3<\/jats:sup> and 29.56 (SD 26.61) cm3<\/jats:sup>, respectively. Patients undergoing necrosectomy, regardless of whether via craniotomy or craniectomy, were more likely to have a favorable outcome at discharge (OR 16.62, 95% CI 2.12\u2013130.33; p = 0.008) and at 3 months (OR 24.12, 95% CI 3.03\u2013192.18; p = 0.003) postoperatively. Postoperative infarct volumes \u2264 17 cm3<\/jats:sup> yielded a sensitivity of 77% and a specificity of 68% with regard to the prediction of favorable outcome at 3 months. The resection \u2265 50% of infarcted tissue was also predictive of favorable outcomes at 3 months (OR 7.7, 95% CI 2.7\u201321.8; p < 0.001).<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nThe reduction of necrotic tissue volumes by at least 50% and\/or the reduction of the infarct volume by \u2264 17 cm3<\/jats:sup> appear to be associated with favorable outcomes in patients with surgically managed ischemic cerebellar strokes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.jns232883","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T01:29:49Z","timestamp":1719624589000},"page":"1681-1686","source":"Crossref","is-referenced-by-count":8,"title":["Surgical infarct volume reduction and functional outcomes in patients with ischemic cerebellar stroke: results from a multicentric retrospective study"],"prefix":"10.3171","volume":"141","author":[{"given":"Silvia","family":"Hernandez-Duran","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Universit\u00e4tsmedizin G\u00f6ttingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Heidelberg University Hospital, Heidelberg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedjan","family":"Behmanesh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rostock University Medical Center, Rostock, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Bernstock","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Harvard Medical School, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Czabanka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazife","family":"Dinc","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Jena University Hospital, Jena; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Dubinski","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rostock University Medical Center, Rostock, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Freiman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rostock University Medical Center, Rostock, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen","family":"Konczalla","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruzanna","family":"Melkonian","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Jena University Hospital, Jena; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee","family":"Mielke","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Universit\u00e4tsmedizin G\u00f6ttingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Klinikum Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Naser","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Heidelberg University Hospital, Heidelberg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veit","family":"Rohde","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Universit\u00e4tsmedizin G\u00f6ttingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Senft","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Jena University Hospital, Jena; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Hendrik","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Neurology, Frankfurt University Hospital, Frankfurt am Main;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Unterberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Heidelberg University Hospital, Heidelberg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae-Yeon","family":"Won","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rostock University Medical Center, Rostock, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Gessler","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rostock University Medical Center, Rostock, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Lancet Neurol","first-page":"215","article-title":"Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials","volume":"6","author":"Vahedi K","year":"2007","unstructured":"Vahedi K, Hofmeijer J, Juettler E. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6(3):215\u2013222."},{"key":"b2","series-title":"World Neurosurg","first-page":"450","article-title":"Suboccipital decompressive craniectomy for cerebellar infarction: a systematic review and meta-analysis","volume":"110","author":"Ayling OGS","year":"2018","unstructured":"Ayling OGS, Alotaibi NM, Wang JZ. Suboccipital decompressive craniectomy for cerebellar infarction: a systematic review and meta-analysis. World Neurosurg. 2018;110:450\u2013459.e5."},{"key":"b3","series-title":"World Neurosurg","first-page":"e723","article-title":"Cerebellar necrosectomy instead of suboccipital decompression: a suitable alternative for patients with space-occupying cerebellar infarction","volume":"144","author":"Hern\u00e1ndez-Dur\u00e1n S","year":"2020","unstructured":"Hern\u00e1ndez-Dur\u00e1n S, Wolfert C, Rohde V, Mielke D. Cerebellar necrosectomy instead of suboccipital decompression: a suitable alternative for patients with space-occupying cerebellar infarction. World Neurosurg. 2020;144:e723\u2013e733."},{"key":"b4","series-title":"World Neurosurg","first-page":"e80","article-title":"Strokectomy and extensive cerebrospinal fluid drainage for the treatment of space-occupying cerebellar ischemic stroke","volume":"115","author":"Tartara F","year":"2018","unstructured":"Tartara F, Bongetta D, Colombo EV. Strokectomy and extensive cerebrospinal fluid drainage for the treatment of space-occupying cerebellar ischemic stroke. World Neurosurg. 2018;115:e80\u2013e84."},{"issue":"3","key":"b5","series-title":"Neurosurgery","first-page":"559","article-title":"Necrosectomy versus stand-alone suboccipital decompressive craniectomy for the management of space-occupying cerebellar infarctions-a retrospective multicenter study","volume":"94","author":"Hernandez-Duran S","year":"2024","unstructured":"Hernandez-Duran S, Walter J, Behmanesh B. Necrosectomy versus stand-alone suboccipital decompressive craniectomy for the management of space-occupying cerebellar infarctions-a retrospective multicenter study. Neurosurgery. 2024;94(3):559\u2013566."},{"key":"b6","series-title":"JAMA Neurol","article-title":"Functional outcomes in conservatively vs surgically treated cerebellar infarcts","author":"Won SY","unstructured":"Won SY, Hern\u00e1ndez-Dur\u00e1n S, Behmanesh B. Functional outcomes in conservatively vs surgically treated cerebellar infarcts. JAMA Neurol. Published online February 26, 2024. doi:10.1001\/jamaneurol.2023.5773"},{"issue":"6","key":"b7","series-title":"J Cereb Blood Flow Metab","first-page":"1096","article-title":"Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke","volume":"38","author":"Hecht N","year":"2018","unstructured":"Hecht N, Neugebauer H, Fiss I, Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke. J Cereb Blood Flow Metab. 2018;38(6):1096\u20131103."},{"issue":"12","key":"b8","series-title":"J Neurointerv Surg","first-page":"1137","article-title":"Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials","volume":"10","author":"Boers AMM","year":"2018","unstructured":"Boers AMM, Jansen IGH, Beenen LFM, Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg. 2018;10(12):1137\u20131142."},{"issue":"10","key":"b9","series-title":"Stroke","first-page":"2569","article-title":"Cerebellar stroke score and grading scale for the prediction of mortality and outcomes in ischemic cerebellar stroke","volume":"54","author":"Won SY","year":"2023","unstructured":"Won SY, Melkonian R, Behmanesh B. Cerebellar stroke score and grading scale for the prediction of mortality and outcomes in ischemic cerebellar stroke. Stroke. 2023;54(10):2569\u20132575."},{"issue":"1","key":"b10","series-title":"J Neurosurg","first-page":"1","article-title":"Second-look strokectomy of cerebral infarction areas in patients with severe herniation","volume":"132","author":"Schwake M","year":"2020","unstructured":"Schwake M, Schipmann S, M\u00fcther M. Second-look strokectomy of cerebral infarction areas in patients with severe herniation. J Neurosurg. 2020;132(1):1\u20139."},{"issue":"1","key":"b11","series-title":"J Neurol","first-page":"149","article-title":"Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence","volume":"269","author":"Moughal S","year":"2022","unstructured":"Moughal S, Trippier S, Al-Mousa A. Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence. J Neurol. 2022;269(1):149\u2013158."},{"key":"b12","series-title":"Front Neurol","first-page":"1017","article-title":"Strokectomy and extensive cisternal CSF drain for acute management of malignant middle cerebral artery infarction: technical note and case series","volume":"10","author":"Tartara F","year":"2019","unstructured":"Tartara F, Colombo EV, Bongetta D, Strokectomy and extensive cisternal CSF drain for acute management of malignant middle cerebral artery infarction: technical note and case series. Front Neurol. 2019;10:1017."},{"key":"b13","series-title":"J Healthc Eng","first-page":"4373404","article-title":"Stereotactic aspiration acts as an effective treatment for malignant middle cerebral artery infarction","volume":"2022","author":"Wang Z","year":"2022","unstructured":"Wang Z, Chen M, Wang C, Luo J, Sun S, Lu X. Stereotactic aspiration acts as an effective treatment for malignant middle cerebral artery infarction. J Healthc Eng. 2022;2022:4373404.Retracted in: J Healthc Eng. 2023;2023:9804673."},{"issue":"35","key":"b14","series-title":"Medicine (Baltimore)","first-page":"e4702","article-title":"Cerebral infarct volume measurements to improve patient selection for endovascular treatment","volume":"95","author":"Han M","year":"2016","unstructured":"Han M, Choi JW, Rim NJ. Cerebral infarct volume measurements to improve patient selection for endovascular treatment. Medicine (Baltimore). 2016;95(35):e4702."},{"issue":"2","key":"b15","series-title":"JAMA Neurol","first-page":"194","article-title":"Mediation of the relationship between endovascular therapy and functional outcome by follow-up infarct volume in patients with acute ischemic stroke","volume":"76","author":"Boers AMM","year":"2019","unstructured":"Boers AMM, Jansen IGH, Brown S. Mediation of the relationship between endovascular therapy and functional outcome by follow-up infarct volume in patients with acute ischemic stroke. JAMA Neurol. 2019;76(2):194\u2013202."},{"issue":"1","key":"b16","series-title":"Circ Res","first-page":"142","article-title":"Inflammatory disequilibrium in stroke","volume":"119","author":"Petrovic-Djergovic D","year":"2016","unstructured":"Petrovic-Djergovic D, Goonewardena SN, Pinsky DJ. Inflammatory disequilibrium in stroke. Circ Res. 2016;119(1):142\u2013158."},{"issue":"1","key":"b17","series-title":"Eur Stroke J","first-page":"20","article-title":"The \"inflammatory penumbra\" in ischemic stroke: from clinical data to experimental evidence","volume":"1","author":"Gauberti M","year":"2016","unstructured":"Gauberti M, De Lizarrondo SM, Vivien D. The \"inflammatory penumbra\" in ischemic stroke: from clinical data to experimental evidence. Eur Stroke J. 2016;1(1):20\u201327."},{"issue":"1","key":"b18","series-title":"Acad Emerg Med","first-page":"63","article-title":"Pitfalls in the diagnosis of cerebellar infarction","volume":"14","author":"Savitz SI","year":"2007","unstructured":"Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14(1):63\u201368."},{"key":"b19","series-title":"Front Neurol","first-page":"580","article-title":"Clinical outcome of isolated cerebellar stroke\u2014a prospective observational study","volume":"9","author":"Nickel A","year":"2018","unstructured":"Nickel A, Cheng B, Pinnschmidt H. Clinical outcome of isolated cerebellar stroke\u2014a prospective observational study. Front Neurol. 2018;9:580."},{"issue":"12","key":"b20","series-title":"Mov Disord","first-page":"1820","article-title":"Development of a brief ataxia rating scale (BARS) based on a modified form of the ICARS","volume":"24","author":"Schmahmann JD","year":"2009","unstructured":"Schmahmann JD, Gardner R, MacMore J, Vangel MG. Development of a brief ataxia rating scale (BARS) based on a modified form of the ICARS. Mov Disord. 2009;24(12):1820\u20131828."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/6\/article-p1681.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/6\/article-p1681.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/6\/article-p1681.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T15:45:21Z","timestamp":1734018321000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/6\/article-p1681.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":20,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2024.3.jns232883","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}