Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

Abstract

One hundred and one consecutive patients with hypertensive cerebellar hemorrhage were analyzed to determine the criteria for surgery. New criteria based on the patient's Glasgow Coma Scale score at admission and the maximum diameter of the hematoma, as disclosed by computed tomography, are proposed from a retrospective analysis of 52 earlier cases. The criteria are as follows: 1) patients with Glasgow Coma Scale scores of 14 or 15 and with a hematoma of less than 40 mm in maximum diameter are treated conservatively; 2) for the patients with Glasgow Coma Scale scores of 13 or less at admission or with a hematoma measuring 40 mm or more, hematoma evacuation with decompressive suboccipital craniectomy should be a treatment of choice; and 3) for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whose general condition is poor, intensive therapy is not indicated. The validity of these criteria was tested and confirmed in 49 recent cases.

Management and Outcome of Non-Traumatic Cerebellar Haemorrhage

“…These results support previous reports, such as those by Kobayashi et al [13]in a relatively large series of 101 patients using the size of the haematoma and the neurological status on admission as guidelines.…”

“…tumours), the presence of signs indicative of brainstem compression or neurological deterioration. These results correlate well with those of Kobayashi et al [13]who found in their large series that patients with a GCS between 13 and 15 and a haematoma size <4 cm had a good outcome with a conservative treatment. Other reports [7, 9, 14, 15, 16]also indicate that a haematoma size of less than 3 cm should be treated conservatively.…”

“…The data suggest that in this subgroup of patients, neurological deterioration is the rule and surgery to remove the cerebellar haematoma should be considered early after the diagnosis is established. This approach is in agreement with most series that conclude that large haematomas should be evacuated [7, 8, 13, 14]regardless of other parameters.…”

“…The management of this group is controversial in the literature. Kobayashi et al [13]concluded that patients with a GCS of 13 or less should be operated regardless of the size of the haematoma. Donauer et al [15], however, concluded that as a first step, ventriculostomy should be done.…”

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

“…The surgical treatment options include craniotomy, stereotactic thrombolysis and/or aspiration, endoscopic lysis and/or aspiration, ventriculostomy and decompressed craniotomy or combination of the above-mentioned procedures. Until now, it was reported that patients with good neurological status (according to GCS with score of 14 or more) and with small hemorrhage (volume of the hematoma less than 40 ml) stand better chances for a full recovery or presence of minor invalidity during the conduction of the conservative treatment (20). Early craniotomy, on the other hand, is recommended for patients with cerebellar hematoma as the degree of neurological deterioration after cerebellar hemorrhage is very high and unpredictable.…”