Predictors of in-hospital mortality after posterior fossa decompression for cerebellar stroke: an exploratory cohort study

Background Surgical intervention for cerebellar insult remains a critical yet high-risk endeavor. This study aimed to explore associations between clinical and volumetric variables and in-hospital mortality in patients undergoing posterior fossa decompression in a hypothesis-generating cohort. Methods We performed a retrospective analysis of 23 patients treated surgically for cerebellar hemorrhage or infarction. A LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression was employed to screen and rank candidate variables associated with death. Variables analyzed included demographics, type of stroke, lesion location (unilateral vs. bilateral/midline), 4th ventricle compression, pre-surgical Glasgow Coma Scale (GCS), and quantitative cerebellar volumes. Results In univariate analyses, type of stroke was associated with survival in this cohort (p=0.014), with deaths observed only among patients with hemorrhage. Bilateral or midline involvement was also associated with mortality (p=0.012). In contrast, pre-surgical GCS and volumetric measures of the lesion and posterior fossa were not significantly associated with mortality. Exploratory LASSO analysis showed positive mortality coefficients for hemorrhage (OR 4.4) and bilateral or midline-crossing lesions (OR 3.6). Conclusions In this exploratory cohort, mortality was more frequently observed in patients with hemorrhagic pathology and bilateral/midline-crossing involvement. These findings are hypothesis-generating and require confirmation in larger cohorts.