Abstract
Recently, minimally invasive techniques, including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, have been used for the treatment of patients with spontaneous cerebellar hemorrhage (SCH). However, credible evidence is still needed to validate the effects of these techniques. To explore the long-term outcomes of both surgical techniques in the treatment of SCH. Fifty-two patients with SCH who received endoscopic evacuation or MIC evacuation were retrospectively reviewed. Six-month mortality and the modified Rankin Scale (mRS) score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of the different surgical techniques on patient outcomes. In the present study, the mortality rate for the entire cohort was 34.6%. Univariate analysis showed that the surgical technique and preoperative Glasgow Coma Scale (GCS) score affected 6-month mortality. However, no variables were found to be correlated with 6-month mRS scores. Further multivariate analysis demonstrated that 6-month mortality in the endoscopic evacuation group was significantly lower than that in the MIC evacuation group (OR = 4.346, 95% CI 1.056 to 17.886). The 6-month mortality rate in the preoperative GCS 9–14 group was significantly lower than that in the GCS 3–8 group (OR = 7.328, 95% CI 1.723 to 31.170). Compared with MIC evacuation, endoscopic evacuation significantly decreased 6-month mortality in SCH patients. These preliminary results warrant further large, prospective, randomized studies.
Highlights
Spontaneous cerebellar hemorrhage (SCH), which is the least common type of intracranial hemorrhage (ICH), accounts for Leiyang Li, Haixiao Liu and Jianing Luo contributed to this work.Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, ChinaInstitute of Basic Medical, the Fourth Military Medical University, Xi’an, Shaanxi, ChinaDepartment of Health Statistics, the Fourth Military Medical University, Xi’an, Shaanxi, China approximately 9 to 10% of all ICH cases [1, 2]
Previous studies have demonstrated that early surgical intervention can decrease the mortality rate in SCH patients associated with brainstem compression or hydrocephalus or with a hematoma > 3 cm in diameter [6,7,8]
52 consecutive patients (27 males and 25 females) were enrolled in the present study according to the selection criteria: there were 27 endoscopic evacuation patients and 25 minimally invasive catheter (MIC) evacuation patients
Summary
Spontaneous cerebellar hemorrhage (SCH), which is the least common type of intracranial hemorrhage (ICH), accounts for Leiyang Li, Haixiao Liu and Jianing Luo contributed to this work. Since the posterior fossa is a narrow space with no additional room for expansion, obstructive hydrocephalus, brainstem compression, and cerebellar herniation arising from the mass effect of hematoma and perilesional edema are major risk factors for a rapidly worsening prognosis in the acute stage [4, 5]. Previous studies have demonstrated that early surgical intervention can decrease the mortality rate in SCH patients associated with brainstem compression or hydrocephalus or with a hematoma > 3 cm in diameter [6,7,8]. Suboccipital craniectomy has been the mainstay surgical intervention for SCH in the past [9, 10]. With the development of less invasive techniques, minimally invasive approaches, including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, have been widely used in clinical practice [11, 12]
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