J Cerebrovasc Endovasc Neurosurg.  2023 Dec;25(4):403-410. 10.7461/jcen.2023.E2023.08.009.

Safe and time-saving treatment method for acute cerebellar infarction: Navigation-guided burr-hole aspiration – 6-years single center experience

• Kim MW
• Park ES
• Kim DW
• Kang SD

• KMID: 2549445
• DOI: http://doi.org/10.7461/jcen.2023.E2023.08.009

Abstract

Objective
While patients with medically intractable acute cerebellar infarction typically undergo suboccipital craniectomy and removal of the infarcted tissue, this procedure is associated with long operating times and postoperative complications. This study aimed to investigate the effectiveness of minimally invasive navigationguided burr hole aspiration surgery for the treatment of acute cerebellar infarction.
Methods
Between January 2015 and December 2021, 14 patients with acute cerebellar infarction, who underwent navigation-guided burr hole aspiration surgery, were enrolled in this study.
Results
The preoperative mean Glasgow Coma Scale (GCS) score was 12.7, and the postoperative mean GCS score was 14.3. The mean infarction volume was 34.3 cc at admission and 23.5 cc immediately following surgery. Seven days after surgery, the mean infarction volume was 15.6 cc. There were no surgery-related complications during the 6-month follow-up period and no evidence of clinical deterioration. The mean operation time from skin incision to catheter insertion was 28 min, with approximately an additional 13 min for extra-ventricular drainage. The mean Glasgow Outcome Scale score after 6 months was 4.8.
Conclusions
Navigation-guided burr hole aspiration surgery is less time-consuming and invasive than conventional craniectomy, and is a safe and effective treatment option for acute cerebellar infarction in selected cases, with no surgery-related complication.

Keyword

Burr hole trephining; Cerebellar infarction; Minimally invasive surgical procedures; Surgical decompression; Surgical navigation systems

Figure

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  Fig. 1. A 65-year-old male patient with acute cerebellar infarction. (A) Brain CT at admission shows acute cerebellar infarction with obstruction of the fourth ventricle (arrows) and mild brain stem compression. The infarction volume is 30.9 ml. (B) CT shows third ventricle dilatation (asterisks) and lateral ventricle anterior horn dilatation (arrows). CT, computed tomography

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  Fig. 2. (A) Postoperative CT; the asterisk shows catheter insertion to allow the side hole to be located at the infarction site to the maximum extent possible. The arrow shows relaxation of the fourth ventricle compression. (B) CT shows improvement of the third ventricle dilatation (asterisks). The arrow shows reduction of the lateral ventricle anterior horn expansion. CT, computed tomography

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  Fig. 3. Intraoperative photograph shows a 3-cm skin incision and insertion of the catheter through the burr hole. The aspirated infarction tissue is observed in the inserted catheter.

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  Fig. 4. After 7 days, CT shows more improvement in the mass effect. (A) The arrow shows a dilated fourth ventricle, and the asterisk shows reduction of the lateral ventricle anterior horn expansion. (B) The asterisk shows favorable changes in the third ventricle dilatation, and the arrow indicates a normal-sized lateral ventricle anterior horn. CT, computed tomography

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