Abstract
Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the authors investigated the risk factors, the indications and the situation of external ventricular drainage (EVD) on the treatment line. Methods: 63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery; the other 27 were received conservative treatment. 15 and 13 cases received EVD in both groups. Hospital stay and mortality rates were investigated. Results: 4 cases in the conservative group underwent surgery secondary to treatment failure. Both of the groups had equal rates of morbidity and mortality. On the other hand, the group that received surgical intervention had shorter median hospital stay. The EVD does not seem to be life-saving at first but it gives time for preparing for surgery. Conclusions: We found that CH was strongly associated with early hydrocephalus and mortality. The early diagnosis and surgical evacuation of the mass are mandatory and life-saving if hematoma is larger than 10 ml. The EVD may not being a life-saving instrument but majorly it may be a time earning device if acute hydrocephalus present.
Highlights
Cerebellar hemorrhage (CH) is a sudden life-threating condition that requires quick diagnosis and fast abolishment of therapeutic approaches
The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence
63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery; the other 27 were received conservative treatment. 15 and 13 cases received external ventricular drainage (EVD) in both groups
Summary
Cerebellar hemorrhage (CH) is a sudden life-threating condition that requires quick diagnosis and fast abolishment of therapeutic approaches. Sir Charles Balance performed the first successful surgical removal of hematoma in 1906 [1] Following his first initiative efforts, the cumulative data on the diagnosis, therapeutic approaches and surgery of the cerebellar hemorrhage were increased up to date with enhanced clinical experience. ; with detailed imaging advances via CT scan, new diagnostic parameters arose such as compression of the fourth ventricle, hydrocephalic changes or hematoma volume in posterior fossa content These measures facilitated the practitioners to decide better on how to treat the patient either surgically or conservatively. After analysis on previous 21 papers published, they conducted the treatment of 33 patients They established a management protocol: Group I, small hematoma in good clinical condition treated conservatively; Group II, cases with hydrocephalus treated with EVD; Group III, large hematoma cases treated surgically. In the present study the authors attempted to try to identify the surgical indications in CH and detailed the usage of EVD as a time earning device in the setting of such cases managed both surgical and conservatively
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