| Objectives To analyze the clinical characteristics of patients with large cerebellar infarction,to explore its relationship with surgical intervention,and to further investigate the predictors of progressive deterioration in patients with large cerebellar infarction,so as to provide a basis for early surgical intervention in patients with large cerebellar infarction.Methods Patients with large cerebellar infarction who attended the Hebei General Hospital from September 2016 to September 2021 were screened,and data related to general information,imaging data and treatment measures were collected.Patients with large cerebellar infarction were divided into surgical intervention group and conservative treatment group by comparing the treatment modalities of patients with large cerebellar infarction in our hospital,and the relationship between clinical characteristics and surgical intervention was investigated;for patients with no indication for surgery at the time of admission,but who might have progressive deterioration after admission,in order to investigate the relationship between clinical manifestations and imaging features(such as infarct volume)and progressive deterioration in such patients,the patients were divided into progressive deterioration group based on post-admission In order to investigate the relationship between clinical presentation and imaging features(e.g.infarct volume)and progressive deterioration in these patients,the patients were divided into progressive deterioration and non-progressive deterioration groups based on the changes in their condition after admission.The data were statistically analysed using SPSS 26.0 statistical software.Multi-factor logistic regression was used to analyse the independent risk factors for progressive deterioration,and the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the risk factors.Results 1 A total of 146 patients with massive cerebral infarction were included in the study and were divided into 25 cases in the surgical intervention group and 121 cases in the conservative treatment group based on their treatment modality.The results of the univariate analysis showed that the presence of headache,persistent headache,unfavourable speech,unsteady walking,restricted eye movements,diplopia,nystagmus,ataxia,Glasgow coma scale(GCS)score on admission or before intervention,quantitative infarct volume,quantitative infarct volume to posterior cranial fossa volume ratio,infarct focus with haemorrhage,infarct involved vessels,four ventricular compression The differences between the two groups were statistically significant(P<0.05).Multi-factor logistic regression analysis showed that tetraventricular compression increased the likelihood of surgical intervention and was statistically significant(OR:31.73,95%CI:4.85-207.71,P<0.001);GCS score at admission or before intervention was a protective factor for surgical intervention and was statistically significant(OR:0.17,95%CI:0.02-1.75,P=0.002).2 A total of 116 patients without surgical indication at admission were included in the study,and were divided into 14 patients in the progressive worsening group and 102 patients in the non-progressive group according to their change in condition.The results of the univariate analysis suggested that the differences between the two groups were statistically significant(P<0.05)for unfavourable speech,diplopia,ataxia,quantitative infarct volume,and quantitative infarct volume to posterior cranial fossa volume ratio.Multi-factor logistic regression analysis showed that quantitative infarct volume and quantitative infarct volume to posterior cranial fossa volume ratio were independent risk factors for progressive worsening of the disease.The ROC curve showed that the area under the receiver operating curve(AUC)for quantitative infarct volume was0.824 and the AUC for quantitative infarct volume to posterior cranial fossa volume ratio was 0.817;the best cut-off value for quantitative infarct volume was 35.8 cm~3(specificity82.4%,sensitivity 78.6%).The best cut-off value for the quantitative infarct volume to posterior cranial fossa volume ratio was 0.21(specificity 86.3%,sensitivity 71.4%).Conclusions 1 Patients with large cerebellar infarcts are more likely to require surgical intervention when they have a low GCS score and four-ventricle compression.2Quantitative infarct volume and quantitative infarct volume-to-posterior cranial fossa ratio are independent risk factors for progressive deterioration in patients with large cerebellar infarcts;imaging of patients with cerebellar infarcts showing quantitative infarct volume>35.8cm~3(infarct volume-to-posterior cranial fossa ratio>0.21,Patients with cerebellar infarction with a quantitative infarct volume>35.8cm~3(infarct volume to posterior cranial fossa ratio>0.21)are at high risk of progressive deterioration and should be considered for early surgical intervention.Figure 2;Table 12;Reference 156... |
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