Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Luparello, V.; Canavero, Sergio

doi:10.1097/00006123-199509000-00037

Cited by 3 publications

(5 citation statements)

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“…Obviously, these findings resulted from the circumstance that before CT, the diagnosis could only be established post mortem with certainty [1]. In recent series, published during the last 10 years, the mortality rate still varies remarkably, ranging from 8 to 58% [3, 4, 5, 7, 9, 10, 13, 17, 18]. However, the comparability of these studies is limited because of different patient selection criteria, heterogeneous management protocols and different observation periods.…”

Section: Discussionmentioning

confidence: 99%

“…However, the comparability of these studies is limited because of different patient selection criteria, heterogeneous management protocols and different observation periods. In most studies, the outcome was assessed at hospital discharge or within the first 6 months after the haemorrhage [3, 5, 10, 17]. It is well recognized that substantial functional improvement in the months following rehabilitation after cerebellar stroke is not uncommon [19], although mortality after cerebral haemorrhage may be primarily determined in the first 3 months [20].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent cause of cerebellar haemorrhage is arterial hypertension, followed by coagulation disorders and vascular malformation [2, 3, 4]. Recent series show that the early mortality varies between 18 and 58% [1, 3, 5, 6, 7]. …”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Dolderer

Kallenberg²,

Aschoff³

et al. 2004

Eur Neurol

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We analysed the clinical and radiological findings and the long-term outcome after 49 ± 34 months in 75 patients (42 men, aged 67 ± 11 years) with spontaneous cerebellar haemorrhage (SCH). At the follow-up examination, 36 patients had died. Outcome was excellent [Rankin Scale (RS) score 0 + 1] in 22 survivors, 4 patients were moderately (RS score 2 + 3) and 13 patients were severely disabled (RS score 4 + 5). Prognostic factors are haematoma volume, intubation, hydrocephalus and clinical signs of brainstem involvement. Of the 28 surgically treated patients, outcome was favourable (RS score 0–2) in 4 patients only, 6 were severely disabled (RS score 3–6) and 18 patients had died. We conclude that the long-term outcome after SCH is frequently favourable. Because patients who were surgically treated had less favourable clinical and radiological findings, a good long-term outcome was rarely present in this group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Dolderer

Kallenberg²,

Aschoff³

et al. 2004

Eur Neurol

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“…La mejoría tras este procedimiento podría derivar en la realización de una evacuación del hematoma, al apuntar a un mejor pronóstico por la ausencia de lesiones establecidas en el TDE 17 . Diversos autores han observado que pacientes en coma (GCS<5-9) con hematomas voluminosos o signos graves de compresión del TDE en TAC experimentaron de forma constante una evolución adversa, expresando sus dudas en cuanto a la indicación de evacuar el hematoma en estos casos 12,16,29,31 . Se reconoce sin embargo, la necesidad de tratar a aquellos pacientes con hidrocefalia y sin signos de grave compresión del TDE independientemente de la gravedad del coma, estimando que la evacuación de la hidrocefalia puede provocar una dramática mejoría 29 .…”

Section: Discussionunclassified

Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte II: Hemorragia infratentorial

Pérez-Núñez¹,

Alday

Rivas

et al. 2008

Neurocirugía

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Surgery plays a mayor role in the management of some patients with cerebellar haematomas, although a universally accepted treatment guideline is lacking. The aim of this study was to review the existing evidence supporting surgical evacuation of the haematoma in this pathology. Without any clinical trial on this field, data derived from clinical series suggest that the level of consciousness, the size of the haematoma, the presence of hydrocephalus and the compression of the posterior fossa CSF containing spaces are the main criteria to decide management. Fourth ventricular compression seems to be the best indicator of the last parameter. Existing bibliography shows that haematomas greater than 4 cm or causing complete obliteration of the fourth ventricle or prepontine cistern need surgical evacuation irrespective of the level of consciousness, as they indicate a significant compression of the brainstem. On the other hand, it seems that haematomas of less than 3 cm and without fourth ventricular compression can be managed conservatively or by means of ventricular drainage if hydrocephalus exists and requires treatment. The management of intermediate sized haematomas is less clear although conservative approach could be adopted in presence of adequate neurological status, with EVD in the case of hydrocephalus with low consciousness level. If the level of consciousness is low despite the treatment of hydrocephalus, or in absence of this latter, haematoma evacuation is indicated. Finally, patients with flaccid tetraplejia and absent oculocephalic reflexes, and those whose age or basal condition precludes an adequate functional outcome are not suitable for aggressive treatment. Moreover, some studies have shown that comatose patients with CT scan evidence of severe brainstem compression present a reduced probability of good outcome. Anyway, management should be decided on an individual basis, as there is no enough evidence to support a strict treatment protocol.

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“…Die Vergleichbarkeit dieser Studien ist stark limitiert, da ganz verschiedene Selektionskriterien und Behandlungsprotokolle verwendet wurden und das Follow-up unterschiedlich lang war. In den meisten Studien wurde das Outcome bei Entlassung oder innerhalb der ersten 6 Monate erhoben [30,31,38,63], wodurch zuverlässige Aussagen über die Langzeitprognose nicht möglich sind. Bei Kleinhirnläsionen kann eine substanzielle Befundbesserung auch längere Zeit nach Abschluss der Rehabilitationsmaûnahmen vorkommen [64]; dagegen wird die Mortalität vermutlich im Wesentlichen vom Verlauf der ersten drei Monate determiniert [65].…”

Section: Prognose Unter Konservativer Und Operativer Therapieunclassified

Spontane Kleinhirnblutung

2004

Akt Neurol

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EinleitungDie Kleinhirnblutung ist keine seltene Erkrankung. Ungefähr 10 % aller intrazerebralen Blutungen sind im Kleinhirn lokalisiert [1 ± 5]. Die ¾tiologie unterscheidet sich nicht grundsätzlich von der bei supratentoriellen Blutungen: Arterielle Hypertonie ist die bei weitem häufigste Ursache, gefolgt von Gerinnungsstö-rungen ± meist infolge Antikoagulanzien ±, Schädel-Hirn-Trauma, Gefäûmalformationen und Tumoren bzw. Metastasen [5 ± 8]. Blutungen durch Hämangioblastome bei der von-Hippel-LindauErkrankung sind typischerweise im Kleinhirn lokalisiert [9]. Im Unterschied zu supratentoriellen Blutungen wird die Amyloidan- ZusammenfassungKonservative Therapieverfahren wurden bisher bei der Kleinhirnblutung nicht untersucht. Vielfach wird eine operative Hä-matomausräumung bei Patienten mit groûen Hämatomen, Hydrozephalus oder Bewusstseinstrübung empfohlen. Die Detailindikation zur Operation wird allerdings sehr unterschiedlich gesehen. Kontrollierte Studien zur Hämatomausräumung bei Kleinhirnblutungen liegen nicht vor. Auch über das optimale chirurgische Verfahren besteht keine Einigkeit. Es werden verschiedene chirurgische Methoden der Hämatomausräumung mit oder ohne Anlage einer Ventrikeldrainage angewendet, ohne dass wissenschaftliche Daten für das jeweilige Verfahren sprechen. Die Langzeitprognose der Kleinhirnblutung ist unklar. Die bisherigen Studien zeigen sowohl unter konservativer und operativer Behandlung eine hohe Mortalität. Die operative Hämatomaus-räumung bei bestimmten Patienten hat sich heute weitgehend durchgesetzt. Aufgrund der dürftigen Datenlage ist der Nutzen dieser Behandlung aber nicht sicher geklärt. AbstractUp to now, specific medical treatment strategies for cerebellar hemorrhage are not established. Usually, surgical hematoma evacuation is recommended in patients with a large hematoma, hydrocephalus or loss of consciousness. However, the indications for surgical interventions are still controversial. Prospective studies on hematoma evacuation in patients with a cerebellar hemorrhage are not available. Furthermore, the optimum surgical treatment strategy remains debatable. The choice of surgical procedure remains highly controversial. Different surgical methods of hematoma evacuation with or without external ventricular drainage are employed. The long-term prognosis after cerebellar hemorrhage has not yet been satisfactorily evaluated. The mortality after surgical or medical treatment is still high. Therefore, although the surgical treatment is firmly established in the current clinical practice, the possible benefits of surgical hematoma evacuations are not proven, and new prospective studies are urgently warranted. Übersicht 180Heruntergeladen von: NYU. Urheberrechtlich geschützt.

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Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Cited by 3 publications

References 3 publications

Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte II: Hemorragia infratentorial

Spontane Kleinhirnblutung

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