Surgical Indication of Hypertensive Cerebellar Hematoma

Abstract

Until now, investigations have indicated that small cerebellar hematomas should be treated conservatively. But the treatment for medium-sized hematoma is still controversial, and the outcome of surgical treatment of large hematomas is not always good. The authors therefore studied the clinical results of hypertensive cerebellar hematomas, especially for medium-sized and large hematomas, and the surgical indication based on preoperative computed tomography (CT) findings and clinical findings was considered. Thirty-seven patients with hypertensive cerebellar hematomas were treated after the introduction of CT scan. In nineteen patients, hematoma evacuations were carried out under suboccipital craniectomy with or without ventricular drainage. In three patients only ventricular drainage or ventriculo-peritoneal shunt was carried out. The other eighteen patients were treated conservatively. In studying the series, the size of hematoma was classified as follows: the maximum diameter of a small hematoma was 2 cm or less, and that of a large hematoma was 3.5 cm or more. The clinical results were evaluated by the activities of daily living on discharge. From the results, the surgical indication of hypertensive cerebellar hematoma was considered as follows: 1) In patients with medium-sized hematoma (more than 2 cm, less than 3.5 cm), alert or somnolent patients should be treated conservatively. Hematoma evacuation is indicated in stuporous patients. 2) In patients with large hematoma (3.5 cm or more), hematoma should be evacuated within 24 hours after onset. Comatose patients, however, cannot achieve an independent daily life.