Cerebellar hematomas: management dilemmas

Abstract

Objectives The aim of the study was to evaluate and investigate the best guidelines for conservative and surgical management of cerebellar hematomas of different etiologies. Patients and methods A prospective and retrospective study was conducted on 36 consecutive patients (20 male and 16 female) admitted to the Tanta Neurosurgical Department during the period from July 2007 to December 2012. We followed the fourth ventricular grading scale, hematoma size, and the Glasgow coma score in our decision-making on the basis of the clinical and neuroimaging studies. Surgical evacuation was performed on 20 of 36 patients. Cerebrospinal fluid diversion was performed on 10 patients (intraoperative external ventricular drainage, ventriculoperitoneal (VP) shunt, Endoscopic third Ventriculostomy (ETV)) either alone or as adjunctive to the surgical evacuation. Sixteen patients did not undergo surgical evacuation. Glasgow coma score was 12 or greater in 20 patients, 8-11 in 11 patients, and 7 or less in five patients. Results The degree of fourth ` ventricular compression was grade I in six patients, grade II in 19, and grade III in 11. Hydrocephalic changes were evident in 19 patients. Intraventricular hemorrhage was detected in computed tomography scans of 16 patients. Thirty-three patients had a history of hypertension, whereas the other three were suffering from bleeding tendencies due to hepatic diseases. Twenty-six patients had good outcome, whereas 10 died due to either recurrence after evacuation because of uncontrollable blood pressure or associated supratentorial hemorrhages or GCS of less than 7 on admission. Conclusion The surgical management of intracerebellar hematomas is still the main strategy; hence, we should correlate the hematoma size, fourth ventricular grade, medical condition of the patient, and initial clinical presentation in the decision-making.