Management and Outcome of Spontaneous Cerebellar Hemorrhage

Han, Jungin; Lee, Ho Kook; Cho, Tack Geun; Moon, Jae Gon; Kim, Chang‐Hyun

doi:10.7461/jcen.2015.17.3.185

Cited by 20 publications

(26 citation statements)

References 25 publications

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“…The current recommendations for operative treatment vary in the literature. Numerous different criteria have been suggested for surgical evacuation or decompression: hematoma diameter >3 cm,[ 16 ] patients with brainstem compression,[ 5 26 ] patients with GCS 4–13 and hematoma diameter >40 mm,[ 14 ] patients with a deteriorating level of consciousness and hematoma volume >10 cm 3 ,[ 9 ] and even operating all patients with a cerebellar ICH has been suggested. [ 2 ] Some authors do not recommend surgical treatment at all because of poor long-term results.…”

Section: Discussionmentioning

confidence: 99%

Treatment of intracerebellar haemorrhage: Poor outcome and high long-term mortality

Satopää¹,

Meretoja²,

Koivunen³

et al. 2017

Surg Neurol Int

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Background:Intracerebellar haemorrhage constitutes around 10% of all spontaneous, non-aneurysmal intracerebral haemorrhages (ICHs) and often carries a grim prognosis. In symptomatic patients, surgical evacuation is usually regarded the standard treatment. Our objective was to compare the in-hospital mortality and functional outcome at hospital discharge in either medically or surgically treated patients, and the impact of either treatment on long-term mortality after a cerebellar ICH.Methods:An observational, retrospective, single-centre consecutive series of 114 patients with cerebellar ICH. We assessed the effect of different demographic factors on functional outcome and in-hospital mortality using logistic regression. We also divided the patients in medical and surgical treatment groups based on how they had been treated and compared the clinical and radiological parameters, in-hospital, and long-term mortality in the different groups.Results:In our series, 38 patients (33.3%) underwent haematoma evacuation and 76 (66.7%) received medical treatment. Glasgow coma scale <8, blocked quadrigeminal cistern, and severe hydrocephalus were associated with in-hospital death or poor functional outcome at discharge (modified Rankin scale 4-6). Surgically treated patients were younger, had larger haematomas both in volume and diameter, were in a worse clinical condition, and suffered more from hydrocephalus and brainstem compression. There were no statistically significant differences in in-hospital or long-term mortality. However, the surgically treated patients remained in a poor clinical condition.Conclusions:Surgical treatment of cerebellar ICH can be life-saving but often leads to a poor functional outcome. New studies are needed on long-term functional outcome after a cerebellar ICH.

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Section: Discussionmentioning

confidence: 99%

Treatment of intracerebellar haemorrhage: Poor outcome and high long-term mortality

Satopää¹,

Meretoja²,

Koivunen³

et al. 2017

Surg Neurol Int

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“…Although not reflected in the results of our multivariate analysis, several studies have found particular radiological risk factors to be predictive of poor outcome, including large hemorrhage size,[ 7 10 17 20 22 23 25 39 ] midline location of hemorrhage[ 30 ] and the presence of IVH. [ 19 23 31 36 ]…”

Section: Discussionmentioning

confidence: 92%

“…[ 28 34 ] In many studies, and consistent with our own results, initial impaired consciousness has been shown to be a strong risk factor for poor outcome after cerebellar hemorrhage. [ 8 11 12 14 17 19 20 28 ] It should be noted that there is conflicting evidence in this regard, with Tsitsopoulos et al . [ 34 ] demonstrating no significant effect of impaired consciousness before surgery on 6-month or long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

Prediction of 30-day mortality in spontaneous cerebellar hemorrhage

Safatli¹,

Guenther²,

McLean³

et al. 2017

Surg Neurol Int

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Background:Cerebellar hemorrhage is a potentially life-threatening condition and an understanding of the factors influencing outcome is essential for sound clinical decision-making.Methods:We retrospectively evaluated data from 50 consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) from 2005 to 2014, analysing their short-term outcomes and identifying possible clinical, radiological and therapeutic risk factors for poor prognosis and death within 30 days.Results:Among 50 patients with first SCH, the mean age was 72 ± 10 years. Median Glasgow Coma Scale (GCS) score on admission was 11 [interquartile range (IQR) = 7–11]. Among 50 patients, 19 patients (38%) underwent surgical hemorrhage evacuation with placement of an external ventricular drain (EVD), 12 patients (24%) received an EVD only and 19 patients (38%) were treated conservatively. The 30-day mortality rate was 36%. In multivariate analysis only the GCS score on admission was a significant predictor of 30-day mortality [odds ratio (OR) = 0.598; 95% confidence interval (CI) = 0.406–0.879; P = 0.009]. For prediction of 30-day mortality, receiver operating characteristic curve analysis confirmed that the best cut-off point was a GCS score of 10 on admission [area under the curve: 0.882, 95% CI = 0.717–1, P < 0.001].Conclusion:Lower GCS score on admission was associated with increased 30-day mortality and poorer short-term outcome in patients with SCH. For patients with a GCS score <10 on admission, it is important to balance the possibility of survival afforded by further therapy against the formidable risk of significant functional disability and poor quality of life.

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

Singh

Brouwers

Senff

et al. 2019

J Neurol Neurosurg Psychiatry

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BackgroundGuidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes.MethodsWe searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and observational cohort studies. We included studies according to predefined selection criteria and assessed their quality according to the Newcastle-Ottawa Scale (NOS) and risk of bias according to a predefined scale. We assessed case fatality and functional outcome in patients treated conservatively or with haematoma evacuation. Favourable functional outcome was defined as a modified Rankin Scale score of 0–2 or a Glasgow Outcome Scale score of 4–5.ResultsWe included 41 observational cohort studies describing 2062 patients (40% female) with spontaneous cerebellar ICH. A total of 1171 patients (57%) underwent haematoma evacuation. Ten studies described a cohort of surgically treated patients (n=533) and 31 cohorts with both surgically and conservatively treated patients (n=638 and n=891, respectively). There were no randomised clinical trials nor studies comparing outcome between the groups after adjustment for differences in baseline characteristics. The median NOS score (IQR) was 5 (4–6) out of 8 points and the bias score was 2 (1–3) out of 8, indicative of high risk of bias. Case fatality at discharge was 21% (95% CI 17% to 25%) after conservative treatment and 24% (95% CI 19% to 29%) after haematoma evacuation. At ≥6 months after conservative treatment, case fatality was 30% (95% CI 25% to 30%) and favourable functional outcome was 45% (95% CI 40% to 50%) and after haematoma evacuation, case fatality was 34% (95% CI 30% to 38%) and 42% (95% CI 37% to 47%).ConclusionsControlled studies on the effect of neurosurgical treatment in patients with spontaneous cerebellar ICH are lacking, and the risk of bias in published series is high. Due to substantial differences in patient characteristics between conservatively and surgically treated patients, and high variability in treatment indications, a meaningful comparison in outcomes could not be made. There is no good published evidence to support treatment recommendations and controlled, preferably randomised studies are warranted in order to formulate evidence-based treatment guidelines for patients with cerebellar ICH.

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Management and Outcome of Spontaneous Cerebellar Hemorrhage

Cited by 20 publications

References 25 publications

Treatment of intracerebellar haemorrhage: Poor outcome and high long-term mortality

Treatment of intracerebellar haemorrhage: Poor outcome and high long-term mortality

Prediction of 30-day mortality in spontaneous cerebellar hemorrhage

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

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