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

Abstract

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.

Intracerebral hemorrhage: an update on diagnosis and treatment

“…Although some studies show an improvement in morbidity and mortality in patients who underwent evacuation for cerebellar ICH [140], others confirm surgical treatment as life-saving but with an increased tracheostomy rate and poor functional outcome [141,142]. A prospective randomized controlled trial seems unlikely due to lack of clinical equipoise.…”

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

“…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.…”

“…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.…”

Spontaneous cerebellar hemorrhage with severe brainstem dysfunction through minimally invasive puncture treatment by locating the simple bedside

“…Spontaneous cerebellar hemorrhage accounts for 5% to 10% of overall cerebral hemorrhages, [1] and the disability rate for cerebellar hemorrhage is 20% to 75% higher than that of the common cerebral hemorrhage. This can mainly be attributed to the obstructive hydrocephalus, which is caused by brainstem compression and bleeding in the ventricular system.…”