Inunediate Surgery Reduces Mortality in Deeply Comatose Patients with Spontaneous Cerebellar Hemorrhage.

Yanaka, Kiyoyuki; Meguro, Kotoo; Fujita, Keishi; Narushima, Kiyoshi; Nose, Tadao

doi:10.2176/nmc.40.295

Cited by 33 publications

(29 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,12 In some cases, even patients with fixed and dilated pupils or other absent brainstem reflexes have recovered. 32 In the series of Hornig et al, 13 38% of comatose patients achieved a good recovery (nondisabled at hospital discharge) after decompressive surgery. In the German -Austrian Cerebellar Infarction Study, half of all patients who deteriorated into coma and were treated with ventricular drainage or decompressive craniotomy experienced a meaningful recovery (modified Rankin score of 2 or less).…”

Section: What Constitutes Futility?mentioning

confidence: 95%

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Amar

2012

FOC

View full text Add to dashboard Cite

Evidence-based guidelines for the management of hemorrhagic and ischemic cerebellar stroke are sparse, and most available data come from Class III studies. As a result, opinions and practices regarding the nature and role of neurosurgical intervention vary widely. A comprehensive literature review was conducted to adjudicate several contentious issues, such as the difference in the management of cerebellar hemorrhage versus infarction, criteria for imaging to exclude an underlying structural lesion, the value of MRI for patient selection, the role of external ventricular drainage, the indications for operative management, the timing of surgical intervention, and various options of surgical technique, among others. Treatment algorithms proposed in several different studies are compared and contrasted. This analysis is concluded by a summary of the recommendations from the American Stroke Association, which advises that patients with cerebellar hemorrhage who experience neurological deterioration or who have brainstem compression and/or hydrocephalus due to ventricular obstruction should undergo surgical evacuation of the hemorrhage as soon as possible, and that initial treatment of such patients with ventricular drainage alone rather than surgical removal of the hemorrhage is not recommended.

show abstract

Section: What Constitutes Futility?mentioning

confidence: 95%

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Amar

2012

FOC

View full text Add to dashboard Cite

show abstract

“…6). 132 Kirollos, et al, 70 prospectively applied a management protocol in 50 consecutive patients with spontaneous cerebellar hemorrhage. They found that evacuation may not be required for hematomas greater than 3 cm if the fourth ventricle was not completely obliterated, but that conscious patients with fourth ventricular obliteration should undergo emergency clot evacuation.…”

mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

148

View full text Add to dashboard Cite

Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

show abstract

“…Immediate surgical relief of brainstem compression is the primary factor for reducing the mortality rate even in deeply comatose patients. 19) In our series, low preoperative GCS, large hematoma, greater hematoma volume, and brainstem compression were significant factors for poor outcome.…”

Section: Discussionmentioning

confidence: 48%

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

Tokimura

Tajitsu

Taniguchi

et al. 2010

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

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.

show abstract

Inunediate Surgery Reduces Mortality in Deeply Comatose Patients with Spontaneous Cerebellar Hemorrhage.

Cited by 33 publications

References 21 publications

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Spontaneous intracerebral hemorrhage: a review

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

Contact Info

Product

Resources

About