A Case of Bilateral Cerebellar Infarction Treated with Suboccipital Decompressive Craniectomy after Thrombectomy for Acute Basilar Artery Occlusion

Abstract

Here we report a case of bilateral cerebellar infarction treated with suboccipital decompressive craniectomy after thrombectomy for an acute basilar artery occlusion. An 83-year-old woman presented with a sudden consciousness disorder. She had a National Institutes of Health Stroke Scale (NIHSS) score of 17 points on admission. Diffusion-weighted imaging (DWI) and computed tomography (CT) angiography revealed acute ischemic bilateral cerebellar stroke due to basilar artery occlusion. Aspiration catheter thrombectomy was immediately performed and modified Thrombolysis in Cerebral Infarction (mTICI) 3 recanalization was achieved. The next morning, CT and DWI revealed bilateral cerebellar swelling with no ischemic lesions at the brain stem. Subsequently, bilateral large suboccipital decompressive craniectomy with duroplasty was performed via an inverted U-shaped skin incision to sufficiently decompress the posterior fossa. After rehabilitation, her clinical course was relatively favorable. She was discharged at 8 months after onset. Her modified Rankin scale score was 4 points at discharge and she was able to walk with assistance. This case demonstrated that an inverted U-shaped skin incision effectively enables sufficient decompression of the posterior fossa for bilateral cerebellar infarction after thrombectomy.