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In-Hospital Management of AIS:
Treatment of Acute Complications
6.4. Cerebellar Infarction (Surgical Management)
COR LOE
Recommendations
1 C-LD
1. In patients with cerebellar infarction and obstructive
hydrocephalus, ventriculostomy is recommended to improve
neurological function and decrease mortality. Concomitant
or subsequent decompressive craniectomy may or may not
be necessary on the basis of factors such as the size of the
infarction, neurological condition, degree of brainstem
compression, and effectiveness of medical management.
1 B-R
2. In patients with cerebellar infarction causing neurological
deterioration from brainstem compression or volumes ≥35
mL, decompressive suboccipital craniectomy with dural
expansion should be performed to improve outcomes and
decrease mortality.
6.3. Supratentorial Infarction (Surgical Management)
COR LOE
Recommendations
2a B-NR
1. In patients with large territorial cerebral infarctions at high risk
for developing brain swelling and herniation, decreased level
of consciousness attributed to brain swelling is a reasonable
trigger for decompressive hemicraniectomy selection.
1 A
2. In patients ≤60 years of age with unilateral MCA infarctions
who deteriorate neurologically within 48 hours from brain
swelling despite medical therapy, decompressive craniectomy
with dural expansion is beneficial to reduce mortality and
improve functional outcome.
2b B-R
3. In patients >60 years of age with unilateral MCA infarctions
who deteriorate neurologically within 48 hours from brain
swelling despite medical therapy, decompressive craniectomy
with dural expansion may be considered to reduce mortality.
2b B-NR
4. In patients with AIS who received IV tPA thrombolysis and
develop malignant cerebral edema despite medical therapy,
early decompressive craniectomy within 48 hours may still be
considered without additional safety concerns.
