130 - Management of Intracerebellar Hematomas and Infarcts

Abstract

This chapter discusses the diagnosis and treatment options for intracerebellar hematomas and infarcts. Cerebellar hemorrhage and cerebellar infarction are two clinical entities with entirely different pathophysiologies, however, the clinical syndrome is quite similar and the surgical treatment and surgical considerations are nearly identical. For this reason, surgical consideration of either cerebellar hemorrhage or cerebellar infarction should be listed under the rather broader category of management of vascular-related mass effect in the posterior fossa. Open suboccipital craniectomy with either a paramedian or midline approach with hematoma evacuation is the standard surgical treatment for cerebellar hemorrhage. Stereotactic aspiration procedures have been described but are less widely accepted at present. These techniques involve aspiration of as much clot as possible with postoperative delivery of fibrinolytic agents through an indwelling catheter to dissolve and aspirate the remaining hematoma. The treatment of cerebellar infarction has also progressed remarkably with the availability of tomographic imaging. Patients with early signs of posterior fossa compression can have immediate confirmation of cerebellar hemorrhage, cerebellar infarction, or other space occupying process in the posterior fossa as well as the presence of associated hydrocephalus, and management schemes can be formulated accordingly.