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

Background and Objectives: Posterior fossa strokes pose specific challenges in terms of management and outcomes. Many patients require intensive care unit (ICU) admission and might require surgical interventions, such as suboccipital decompressive craniectomy (SDC). The objective of this study was to describe the clinical chacteristics, management and outcomes of posterior fosa stroke patients admitted to ICU and to identify risk factors associated with outcomes and surgical management Methods This is a retrospective monocentric study of patients that were admitted to a tertiary hospital neuro-ICU for a cerebellar stroke. Clinical characteristics, surgical management and outcome were retrieved from medical files. Good functionnal outcome, defined as a mRS score < 2, was assesed at one year. Results 53 patients were included. At one year follow-up, 22/53 (41.5%) of patients had a good functional outcome. 26/53 (49%) were treated by SDC and 26/53 (49.1%) had an EVD. ICU mortality was 23%, with a one-year mortality rate of 32%. Factors associated with SDC were volume of the lesion, brainstem compression on neuroimaging and level of consciousness. We found no association between 1-year functional outcome (mRS) and SDC. Younger age (under 50 years old), higher level of consciousness on admission, and absence of signs of brainstem compression were associated with a better outcome. Conclusion We found that patient admitted in ICU for posterior fossa vascular space occupying lesions had a poor one-year functional outcome with no benefit observed from SDC. SDC should be adequately evaluated in further interventional randomized trials.