Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage

Abstract

Postoperative rebleeding (PRB) is one of the most severe complications after hematoma evacuation of spontaneous intracerebral hemorrhage (ICH). PRB has been proven to be an independent risk factor for poor prognosis. Previous studies have shown that spot sign and blend sign are independent risk factors for PRB of spontaneous ICH. However, the risk factors for PRB of spontaneous cerebellar hemorrhage (SCH) have not been elucidated. The aim of the present study was to investigate the possible risk factors for PRB and shortterm prognosis of patients with SCH. Patients and Methods: This study identified 62 patients with SCH who underwent hematoma evacuation in our department. Risk factors for PRB and short-term prognosis were identified by a univariable logistic regression model, and predictors with a P value of less than 0.05 were included in the multivariable logistic regression model to identify independent predictors. A receiver operating characteristic (ROC) curve was created to test the sensitivity and specificity of independent risk factors. Results: Hematoma volume was the only independent predictor of PRB (OR=15.14, 95% CI=1.08-213.1, P=0.044). The sensitivity and specificity of hematoma volume to PRB were 63.6% and 89.7%, respectively, and the cutoff value of hematoma volume was >29.3 mL. GCS score ≤8 (OR=5.131, 95% CI=1.030-25.554, P=0.046) and PRB (OR=13.17, 95% CI=1.316-131.798, P=0.028) were independent risk factors for poor prognosis of patients with SCH. The sensitivity and specificity of the GCS score to poor prognosis were 66.7% and 86.2%, respectively. The sensitivity and specificity of the PRB to poor prognosis were 36.4% and 96.6%, respectively. Conclusion: Hematoma volume is likely to be a strong predictor of PRB among patients with SCH. GCS scores ≤8 on arrival and PRB were significant predictors of short-term poor outcome.

Clinical Outcome Following Surgical Evacuation of Spontaneous Cerebellar Hematomas

“…1,2 Spontaneous cerebellar hematoma constitutes about 10% of the intracerebral hematomas. 3,4,5 They have a worse prognosis than their supratentorial counterpart. [4][5][6][7][8] The mortality is very high and reaches 30 -50%.…”

“…3,4,5 They have a worse prognosis than their supratentorial counterpart. [4][5][6][7][8] The mortality is very high and reaches 30 -50%. 4,9,10 Historically, surgical evacuation of cerebellar hematomas has been considered the preferred mode of treatment.…”

“…[4][5][6][7][8] The mortality is very high and reaches 30 -50%. 4,9,10 Historically, surgical evacuation of cerebellar hematomas has been considered the preferred mode of treatment. 4,5,9 However, the evidence favoring surgical evacuation of cerebellar hematomas has been based on observational and retrospective studies with a small sample size.…”

“…4,9,10 Historically, surgical evacuation of cerebellar hematomas has been considered the preferred mode of treatment. 4,5,9 However, the evidence favoring surgical evacuation of cerebellar hematomas has been based on observational and retrospective studies with a small sample size. 5,9 Whether surgical evacuation actually leads to improved outcome remains controversial and a debated topic.…”

“…5,9 Whether surgical evacuation actually leads to improved outcome remains controversial and a debated topic. 4,7,9 Studies addressing the topic have shown contrasting results with some studies reporting that surgical evacuation led to a good outcome, 7,11 whereas others finding surgical evacuation to be no better than conservative management 9,10 or even leading to a worse outcome compared to the conservative treatment. 5,12 Even the surgical indications based on the hematoma size and preoperative clinical status vary, and the opinions diverge from carrying out the surgical evacuation of all hematomas to managing all the hematomas conservatively.…”