Medical and surgical treatment of intracerebellar haematomas

Abstract

15 cases of intracerebellar haematomas [11 spontaneous, 2 traumatic and 2 unclear] were presented. Hypertension was thought to be a main risk factor in 91% in 11 of the spontaneous cases. 11 cases were treated medically. They were usually conscious, scoring not less than 13 in GCS with subacute or chronic picture of illness and harbouring small haematomas below 3 cm in diameter situated almost always in the hemisphere and with no signs of ventricular dilation. Mortality in medically treated patients was 9% [1 case]. The remainder were discharged in good state, usually with no or only slight neurological deficit. Complete haematoma absorption took about 14 days. There were no signs of delayed hydrocephalus in subsequent CT scans. When the haematoma was large, more than 3 cm in diameter, located usually in the vermis or in the vermis and cerebellar hemisphere, sometimes with ventricular involvement, the clinical presentation was acute and required CT diagnosis and surgical evacuation without delay due to low and deteriorating conscious level. Postoperative mortality was 25%, but delayed mortality was 100%. Vertebral angiography was performed in all cases of spontaneous haemorrhage and was normal in 54%, revealed atheromatous changes in 36% and the signs of cerebellar haematoma in only 10%. Arteriovenous malformations were excluded from this study. The authors believe, that the benign course of intracerebellar haematomas is more frequent than it was considered previously and needs no surgical treatment in many cases.

Controversies in the management of spontaneous cerebellar haemorrhage a consecutive series of 49 cases and review of the literature

“…In most published series, arterial hypertension is the most common aetiological factor ~' TM 15,19,28,30,31,40, 4~, responsible for approximately 70 percent of cases. It is believed that these haemorrhages originate in micro-aneurysms, first described by Charcot and Bouchard, and recently confirmed 4s.…”

Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

“…Occasionally, a good outcome after medical treatment also in patients with unfavourable initial clinical findings or with a large haematoma has been described [29, 31, 32]. Anecdotal reports advocate that a good outcome is still possible in comatose patients after immediate haematoma evacuation [9, 10, 33, 34].…”

Prognostic factors in the treatment of cerebellar haemorrhage

“…Nonwithstanding many elaborate studies on the subject ~, 4,5,13,18,19,22,23,25,26,30,33,35,37, at the present time no formally accepted common management strategy exists 39, and accordingly no general aggreement whether, when and how the patients should be operated upon. But it seems to be mostly accepted that a haematoma with a diameter larger than 3 cm should be operated upon 21.…”