Burr Hole Endoscope-Assisted Evacuation of Cerebellar Hematomas (ICH)

Abstract

Introduction: Cerebellar hematomas frequently represent surgical emergency due to the limited space of the posterior cranial fossa. They could cause cerebellar edema and dislocation, obstruction of the aqueduct of Sylvius, obstruction or penetration of the fourth ventricle, compression of the brain stem and in the most severe cases - cerebellar tonsillar herniation. In patients with cerebellar hematomas, neurosurgical treatment could be performed by different methods. The minimally invasive burr hole craniotomy with endoscope-assisted evacuation of the life-threatening cerebellar hematomas represents a viable technique of surgical treatment. Materials and Methods: For a period of 5 years, 14 burr hole endoscope-assisted evacuations of cerebellar hematomas were accomplished . Patient selection was based on defined criteria derived from a profound analysis of the pertinent literature. The patients were followed-up clinically and radiologically as morbidity, mortality, and rebleeding rates were specified. Glasgow Outcome Scale (GOS) was studied three months after the procedure. Results: Transparent trocars were used for endoscope-assisted evacuation of cerebellar hematomas with penetration into the ventricular system in 5 patients and in 9 without penetration. The timing of the procedures was within 24 hours after the clinical manifestation. The mean operative time was 65 minutes. The mortality rate was 28.5 % (4 cases). The morbidity associated with hydrocephalus was 14.28% (2 cases)- VPA shunts were placed 1 month after surgery. Percentage of repeat bleeding was 21.4% (3 cases). GOS average result was 4 at 3-month follow-up. Conclusion: The data suggest that the minimally invasive endoscope-assisted evacuation is an effective and reliable treatment option for cerebellar hematomas.