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

Abstract

The efficacy and safety of cerebellar hemorrhage evacuation by key hole craniotomy and the importance of thorough evacuation and irrigation of the hematoma in the fourth ventricle to resolve obstructive hydrocephalus were assessed in 23 patients with spontaneous cerebellar hemorrhage (SCH) greater than 3 cm or with brainstem compression and hydrocephalus. A 5-cm elongated S-shaped scalp incision was made, and a 3-cm key hole craniotomy was performed over a cerebellar convexity area. The hematoma was immediately evacuated through a small corticotomy. The hematoma in the fourth ventricle was gently removed through the hematoma cavity, followed by thorough saline irrigation to release obstructive hydrocephalus. Patients classified retrospectively into favorable and poor outcome groups using the Glasgow Outcome Scale (GOS) scores of 4-5 vs. 1-3 showed significant differences with respect to the preoperative Glasgow Coma Scale, hematoma size and volume, and brainstem compression. Only 2 of the 23 patients required ventricular drainage and no postoperative complications were recorded. Patients treated by experienced and inexperienced surgeons showed no significant differences in the hematoma evacuation rate, postoperative GOS, and interval from skin incision to start of hematoma evacuation. Our simplified method of key hole craniotomy to treat SCH was less invasive but easy to perform, as even inexperienced neurosurgeons could obtain good surgical results. Thorough cleaning of the fourth ventricle minimized the necessity for ventricular drainage.

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

“…Of these 121 articles, 41 (34%) articles fulfilled the predefined inclusion criteria and were therefore included in this systematic review (figure 1). 4 12–51 The 41 eligible studies described 2062 patients (40% female) of which 1171 (57%) underwent haematoma evacuation and 891 (43%) did not. Thirty-seven (90%) studies had a retrospective design.…”

“…Based on the available literature and its limitations as described previously, there is currently insufficient published evidence to guide treatment decisions on when and for whom haematoma evacuation for spontaneous cerebellar ICH should be performed 13–51. Ultimately, randomised clinical trials may well be needed to assess the role of haematoma evacuation in patients with spontaneous cerebellar ICH.…”

Use of the Image Guided Minimally Invasive BrainPath System to Evacuate Spontaneous Cerebellar Hemorrhages

“…In this technique, we performed a retrosigmoid craniotomy to gain direct access to the hematoma location. The retrosigmoid craniotomy is also known as "the keyhole craniotomy" because it is a minimally invasive approach that provides safe and easy access to the brainstem and cerebellum [ 12 ]. In this case, we performed a retrosigmoid craniectomy in order to compensate for any potential secondary swelling that may occur.…”

Initial Experience With the NICO Myriad Device for Minimally Invasive Endoscopic Evacuation of Intracerebral Hemorrhage

“…5,27 Previous studies have reported success and favorable patient outcome with MIS keyhole craniotomy for evacuation of cerebellar ICH. 28,29 An early study of endoscopic cerebellar hemorrhage evacuation showed superiority over evacuation through suboccipital craniectomy, with significantly shorter procedure times and decreased need for shunt placement. 30 More recent studies have also found surgical advantages to the endoscopic technique for cerebellar ICH evacuation, including for patients with severe fourth ventricle compression.…”