Neurosurgical management of cerebellar hemorrhage

Abstract

Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness. Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients. Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.

Paramedian Suboccipital Mini-Craniectomy for Evacuation of Spontaneous Cerebellar Hemorrhage

“…10,18) Patients with early disturbance of consciousness due to SCH with brain stem compression who show upward transtentorial herniation on CT should undergo immediate posterior fossa surgery. 16) The target of SCH surgery is to evacuate the hematoma. 7,11,12,16) Only ventricular drainage leads to the same mortality as for untreated patients, since it does not relieve brain stem compression and carries the risk of upward herniation.…”

“…16) The target of SCH surgery is to evacuate the hematoma. 7,11,12,16) Only ventricular drainage leads to the same mortality as for untreated patients, since it does not relieve brain stem compression and carries the risk of upward herniation. 7,[10][11][12][13]15,16) Treatment of patients with SCH may be either conservative or surgical.…”

“…7,[8][9][10][11]17,18) Standard large suboccipital craniectomy provides good exposure and enough room to accommodate postoperative swelling of the cerebellum, so has become the standard treatment for SCH. 10,16) However, this is a stressful procedure for patients due to the long operating time and prone position, and is often complicated by postoperative liquorrhea due to the large dural incision. In contrast, the present series showed no patient required dural repair after mini-craniectomy and postoperative liquorrhea was reduced.…”

“…7,8,11,12,16) The diagnosis must be established rapidly because most patients die within 48 hours of onset and deterioration to deep coma always results in death. 2,10) Such deterioration may be a consequence of brain stem compression, suggesting that direct evacuation of the hematoma should be performed as soon as possible.…”

Efficacy and Safety of Key Hole Craniotomy for the Evacuation of Spontaneous Cerebellar Hemorrhage

“…6,8,11,12,14,17) SCH accounts for approximately 10% of all intracerebral hemorrhages. Patients with cerebellar hematomas larger than 3 cm in diameter may benefit from emergency surgical evacuation 2,5,7,17) because it is unwise to defer intervention until aggravation of their neurological condition renders them comatose. The goal of surgery in patients with large SCH is to eliminate the risk to life by immediate hematoma evacuation and to release obstructive hydrocephalus.…”