Abstract

BackgroundIn patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation.MethodsWe included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome.ResultsOf 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0–3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0–3).ConclusionsWhile cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.

Highlights

  • Spontaneous intracerebral hemorrhage (ICH) is the most lethal form of stroke, and its incidence is 10–30 patients per 100,000 persons per year worldwide [1]

  • The American Heart Association (AHA) guidelines advocate for immediate surgery in patients with spontaneous cerebellar hemorrhage with a diameter of > 3 cm or those showing signs of brainstem compression or hydrocephalus [9]

  • Study Design We studied a consecutive series of patients with spontaneous cerebellar hemorrhage > 3 cm admitted between December 2008 and July 2017 to the University Medical Center Utrecht (UMCU) or between January 2012 and January 2018 to the Radboud University Medical Center (RUMC), both in the Netherlands

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Summary

Introduction

Spontaneous intracerebral hemorrhage (ICH) is the most lethal form of stroke, and its incidence is 10–30 patients per 100,000 persons per year worldwide [1]. Neurosurgical treatment can be life-saving and is performed more often in cerebellar ICH compared to supratentorial ICH [7]. The American Heart Association (AHA) guidelines advocate for immediate surgery in patients with spontaneous cerebellar hemorrhage with a diameter of > 3 cm or those showing signs of brainstem compression or hydrocephalus [9]. This recommendation is based on small, observational studies [10]. In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation

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