Surgical versus medical treatment of spontaneous posterior fossa haematomas: A cooperative study on 205 cases

Pian, R. Da; Bazzan, Alberto; Pasqualin, A.

doi:10.1080/01616412.1984.11739680

Cited by 122 publications

(67 citation statements)

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“…(5) Da Pian et al also reported a high mortality rate of 38% for cerebellar haematomas. (11) Controversy still exists regarding the most appropriate management for cerebellar strokes. (12)(13)(14) Some neurosurgeons prefer conservative treatment, while others believe in early posterior fossa decompression.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are many published reports on cerebellar strokes, only a few have quantified the functional outcomes of cerebellar strokes. (5,7,8,11) Therefore, the aim of the present study was to quantify and compare the differences in the outcomes of patients with cerebellar infarct and patients with cerebellar haemorrhage, as well as to identify risk factors that predict poor outcomes in patients with cerebellar strokes.…”

Section: Introductionmentioning

confidence: 99%

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Cerebellar strokes: a clinical outcome review of 79 cases

Ng¹,

Yang²,

Seet³

et al. 2015

smedj

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebellar strokes: a clinical outcome review of 79 cases

Ng¹,

Yang²,

Seet³

et al. 2015

smedj

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“…1 Clinical trials assessing surgical therapy for ICH have not shown an effect on functional outcome, although benefit has been shown for cerebellar hematomas larger than 3 cm in observational studies. 2,3 Systematic reviews also suggest a beneficial effect for specific subgroups in supratentorial ICH. 4,5 Based on those results, STICH II evaluated surgery for patients with superficial hematomas (#1 cm of the cortex) without intraventricular extension.…”

mentioning

confidence: 99%

CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery

et al. 2014

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Objective: To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH). Methods:In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression.Results: A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; $1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8). Conclusions:The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials. Neurology ® 2014;83:883-889 GLOSSARY CI 5 confidence interval; CTA 5 CT angiography; ICH 5 intracerebral hemorrhage; MGH 5 Massachusetts General Hospital; OR 5 odds ratio; UMCU 5 Utrecht University Medical Center.Intracerebral hemorrhage (ICH) remains the most lethal form of stroke, with 1-month mortality rates of 40%.1 Clinical trials assessing surgical therapy for ICH have not shown an effect on functional outcome, although benefit has been shown for cerebellar hematomas larger than 3 cm in observational studies.2,3 Systematic reviews also suggest a beneficial effect for specific subgroups in supratentorial ICH. Thus, a tool to identify patients who may benefit from surgery is warranted. A robust marker of ongoing bleeding, studied extensively over the last 10 years, is the CT angiography (CTA) spot sign ( figure 1B). 7 The spot sign is commonly assumed to represent continued bleeding (e.g., contrast extravasation visualized on CTA after contrast bolus injection) from ruptured

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“…Several nonrandomized studies showed beneficial outcomes for cerebellar hematomas with a diameter exceeding 3 cm, or causing hydrocephalus or brainstem compression, when surgically evacuated compared to medical treatment only [107][108][109][110]. In another study, best results were obtained by surgery in patients with a GCS below 14 or hematomas with a volume of 40 mL or more [111].…”

Section: Cerebellar Hematomasmentioning

confidence: 99%