Spontaneous Cerebellar Hematomas Research Articles

Surgical management of spontaneous posterior fossa hematoma: predictors of the neurological outcome

ObjectiveTo detect demographic, clinical, and radiological predictors of patient outcomes and prognosis in spontaneous cerebellar hematoma patients that may guide accurate decision making.MethodsThis retrospective study was conducted on 45 patients with spontaneous cerebellar hematoma who underwent surgical treatment. The patient data including demographics (age, gender), preoperative consciousness at the time of admission, medical comorbidities (HTN, DM), radiological findings (location, volume, and diameter of the cerebellar hematoma, hydrocephalus, compression of the fourth ventricle, effacement of the quadrigeminal cistern, intraventricular hematoma, tight posterior fossa, and brain stem compression), and treatment methods were collected and correlated with prognosis. Outcome assessment was done using the Glasgow Outcome Scale (GOS), classified into good outcome (favorable result; GOS > 4) and poor outcome (unfavorable result; GOS < 4).ResultsThere was a statistically significant correlation (p = 0.030) between the time to surgery and GOS, with more favorable outcomes in patients who underwent early surgery compared to late surgery. Unfavorable outcomes were detected in patients with higher Taneda grade and Kirollos grade, and both were statistically significant (p = 0.001). The presence of hydrocephalus and/or brainstem compression had a statistically significant (p < 0.001) negative impact on outcomes. Patients with extensive IVH had an unfavorable outcome compared to other patients (p = 0.016). The mortality rate in our study was 28.9%.ConclusionsSurgical management of spontaneous cerebellar hematoma is challenging. Many factors influence the appropriate decision making and surgical outcome. Predictors of an unfavorable outcome include the level of consciousness at admission, delayed time to surgery, a higher grade of 4th ventricular effacement (Kirollos) and quadrigeminal cistern effacement (Taneda), extensive IVH, hydrocephalus, and brainstem compression (statistically significant). There was no statistical significance regarding gender, age, hematoma volume, or hematoma diameter in relation to an unfavorable outcome.

Clinical Outcome Following Surgical Evacuation of Spontaneous Cerebellar Hematomas

Objective: debated. The present study was designed to analyze the clinical outcome of patients operated in our department for spontaneous cerebellar hematoma evacuation.&#x0D; Method: The medical data of all the patients in whom spontaneous cerebellar hematoma had been surgically evacuated were retrospectively analyzed. The parameters of age, preoperative Glasgow coma scales (GCS), and the volume of the hematoma was studied and their relationship with clinical outcome based on the Glasgow outcome scale (GOS) was analyzed&#x0D; Results: The study included twenty-four patients. Fourteen (58.3%) patients survived and ten (41.7%) patients expired. The mean age of the surviving patients was 57 years and the mean age of the expired patients was 57.2 years. The difference wasn’t statistically significant (p = 0.9612). The mean hematoma volume in the surviving patients was 23 cm3 and in the expired patients was 26.2 cm3. The difference didn’t reach statistical significance (p = 0.1614). The mean preoperative GCS of the surviving patients was 12.4 and of the expired patients were 8.3. This difference was statistically significant (p = 0.004). All the surviving patients had a favorable outcome based on the GOS score&#x0D; Conclusion: Surgical evacuation of cerebellar hematomas leads to a good clinical outcome. Preoperative GCS is significantly associated with the clinical outcome. The age of the patient and the volume of the hematoma were not found to be significantly associated with the clinical outcome

Role of early surgical intervention in outcome and prognosis of spontaneous cerebellar hemorrhage with intraventricular extension

Spontaneous cerebellar hematomas represent 5 to 13% of all cases of spontaneous intracranial hemorrhage. The main controversy involves deciding which cases require surgical evacuation of the hematoma versus other options, such as ventricular drainage only or conservative treatment. Furthermore, because the clinical course is variable in some cases, timing of such treatment should be carefully considered. The duration from the onset of hemorrhage also plays an important role in prognosis and recovery of the patient. Both the clinical presentation and subsequent course vary among cases. Unpredictable rapid deterioration in consciousness levels has been recognized. The majority of patients with such decline in consciousness experience the deterioration primarily within 72 hrs after onset⁠. Acute presentation was observed to be correlated with poor outcomes. In our report, the first case presented with sudden onset of headache in the right frontal region of head with vertigo. He came to hospital within 6 hours of onset. However, the second case had an onset of symptoms around 72 hours before the presentation.

Anaesthetic management for caesarean section and craniotomy at the same session in a pregnant patient with spontaneous cerebellar hematomas

Anaesthetic management for caesarean section and craniotomy at the same session in a pregnant patient with spontaneous cerebellar hematomas

Surgical Management of Moderate Sized Spontaneous Cerebellar Hematomas: Role of Intracranial Pressure Monitoring.

Acute onset spontaneous cerebellar hematoma (SCH) is a neurosurgical emergency with unpredictable natural history and outcome. Specific guidelines are available for management of small ( < 2.5 cm) and large sized (4.0 cm < ) SCH. But, literature is sparse for treatment of moderate sized SCH (2.5-4.0 cm). In a retrospective analysis of 32 patients, with moderate sized acute SCH, external ventricular drainage (EVD) tube was inserted for evaluation of ICP and evacuation of cerebrospinal fluid. All patients with ICP > 25 mmHg underwent emergency SCH evacuation. Postoperatively, EVD was continued for 48-72 hours for ICP monitoring. Patients showing no improvement or persistent ventriculomegaly underwent ventriculoperitoneal shunt (VPS) insertion for the management of hydrocephalus. 29/32 patients needed operative intervention either in the form of hematoma evacuation or shunt placement. 10 patients improved to GOS 5 and 7 to GOS 4. Overall mortality was 25% (n=8). Despite SCH evacuation, none of the patients with ICP > 40 mmHg experienced good outcome (p < 0.0001). 47% of patients with moderate sized SCH need surgical evacuation. EVD insertion not only helps in ICP management but also includes the ability to gradually decompress ventricular system by varying the outflow pressure. Apart from radiologic findings, ICP measurement should be a guideline in management decisions.

Late favorable results of duroplasty with biocellulose: clinical retrospective study of 20 cases

Abstract Objective: Considering the importance of dural replacement in neurosurgery, mainly in times of advanced endoscopic skull base approaches, the authors report the late results after implanting of pure biocellulose membrane in 20 patients harboring different types of lesion, from 1996 to 1999, with objective of demonstrate its use in neurosurgery. Method: The casuistic was followed clinically and image studies were indicated when necessary. Dural substitution was achieved by continuous 4:0 prolene suture without additional glue. Results: The casuistic is constituted by four convexity or parasagittal meningiomas, three single cortical metastasis (melanoma, lung and renal carcinomas), two cerebellar gliomas (one multicentric GBM, one pilocytic cerebellar astrocytoma), one decompressive craniectomy for brain edema due to vasosespasm after aneurysm clipping one decompressive craniotomy for cerebral edema after hemorrhage of a giant fronto-parietal AVM, two mirror MCA aneurysms, one pineal and mesencephalic astrocitoma, one quadrigeminal cistern cyst, one accoustic schwanoma, one spontaneous cerebellar hematoma, one decompressive neurovascular operation for trigeminal neuralgia; 1 cauda equina ependimoma, one lombar myelomeningocele. Currently nine patients are alive, none had direct complication of implant. Recent NMR images of survivors do not show the membrane. Three wound infections could not be definitively attributed to patch. Conclusion: The material was considered safe for dural replacement. Due to inadequate elasticity of pure cellulose, the research was interrupted, waiting for a better product, which is currently being tested.

Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage : Risk Factors Associated with Ventriculoperitoneal Shunt

ObjectiveThe purposes of this study are to investigate the factors that may be related to ventriculoperitoneal (VP) shunt in patients with cerebellar hematoma and the effect of severe fourth ventricular hemorrhage, causing obstructive hydrocephalus on subsequent VP shunt performance.MethodsThis study included 31 patients with spontaneous cerebellar hematoma and concomitant fourth ventricular hemorrhage, who did not undergo a surgical evacuation of hematoma. We divided this population into two groups; the VP shunt group, and the non-VP shunt group. The demographic data, radiologic findings, and clinical factors were compared in each group. The location of the hematoma (whether occupying the cerebellar hemisphere or the vermis) and the degree of the fourth ventricular obstruction were graded respectively. The intraventricular hemorrhage (IVH) score was used to assess the IVH severity.ResultsTen out of 31 patients underwent VP shunt operations. The midline location of cerebellar hematoma, the grade of fourth ventricle obstruction, and IVH severity were significantly correlated with that of VP shunt operation (p=0.015, p=0.013, p=0.028). The significant variables into a logistic regression multivariate model resulted in statistical significance for the location of cerebellar hemorrhage [p=0.05; odds ratio (OR), 8.18; 95% confidence interval (CI), 1.00 to 67.0], the grade of fourth ventricle obstruction (p=0.044; OR, 19.26; 95% CI, 1.07 to 346.6).ConclusionThe location of the cerebellar hematoma on CT scans and the degree of fourth ventricle obstruction by IVH were useful signs for the selection of VP shunt operation in patients with spontaneous cerebellar hematoma and concomitant acute hydrocephalus.

Spontaneous Cerebellar Hematomas

Background Spontaneous cerebellar hematoma (SCH) is not a very common cause of stroke and constitutes 10% of all intracranial hemorrhages. Aim To study the demographic features and assess the clinical and radiologic predictors of the outcome of SCHs. Patients and Methods A retrospective study of 49 patients with a diagnosis of SCH admitted to the National Institute of Mental Health and Neurosciences, Bangalore, India, from 1993 to 2004 was carried out. Clinical features and radiologic parameters were analyzed and correlation with outcome was evaluated. Results The Glasgow coma scale (GCS) score and tight posterior fossa had a strong bearing on the outcome. Conclusions Poor GCS and tight posterior fossa are predictors of poor outcome whereas clot volume has no bearing.

Hematomas cerebelosos. Descripción de una cohorte y pronóstico en función de la actitud terapéutica

Spontaneous cerebellar hematomas (CH) represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical treatment) and the subsequent course of the patients. Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. Fifty-six consecutive patients diagnosed of CH. VARIABLES OF PRINCIPAL INTEREST: We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS), hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale--GOS). Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. Patients with GCS < or = 8 and hematoma size > or = 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment.

Management of spontaneous cerebellar hematomas: a prospective treatment protocol.

To identify easily applicable guidelines for the surgical and conservative management of spontaneous cerebellar hematomas. A treatment protocol was developed and prospectively applied for the management of 50 consecutive cases of cerebellar hematomas. The appearance of the fourth ventricle, adjacent to the hematoma, on computed tomographic scans was divided into three grades (normal, compressed, or completely effaced). The degree of fourth ventricular compression was correlated with the size and volume of the hematoma and the presenting Glasgow Coma Scale (GCS) score. The hematoma was surgically evacuated for all patients with Grade III compression and for patients with Grade II compression when the GCS score deteriorated in the absence of untreated hydrocephalus. Patients with Grade I or II compression were initially treated with only ventricular drainage in the presence of hydrocephalus and clinical deterioration. The degree of fourth ventricular compression was classified as Grade I in 6 cases, Grade II in 26, and Grade III in 18. The degree of fourth ventricular compression was significantly correlated with the volume of the hematoma (r(s) = 0.67, P < 0.0001), hydrocephalus (r(s) = 0.44, P = 0.001), the preoperative GCS score (r(s) = 0.43, P = 0.001), the maximal diameter of the hematoma (r(s) = 0.43, P = 0.001), and a midline location of the hematoma (chi(2) = 6.84, P < 0.009). Acute deterioration in GCS scores occurred for 6 (43%) of 14 patients with Grade III ventricular compression who were conscious at presentation. Thirteen patients with Grade I or II ventricular compression and stable GCS scores of more than 13 were treated conservatively. Nine patients were treated with ventricular drainage only, and 28 underwent posterior fossa craniectomy and evacuation of the hematoma with ventricular drainage. The mortality rate at 3 months was 40%. None of the patients with Grade III fourth ventricular compression and GCS scores of less than 8 at the time of treatment experienced good outcomes. Overall, 15 (60%) of 25 patients with hematomas with maximal diameters of more than 3 cm and Grade I or II compression did not require clot evacuation. Conscious patients with Grade III fourth ventricular compression should undergo urgent clot evacuation before deterioration. Surgical evacuation of the clot may not be required for large hematomas (>3 cm) if the fourth ventricle is not totally obliterated at the level of the clot.

Clinician’s Biases toward Surgery in Cerebellar Hematomas: An Analysis of Decision-Making in 94 Patients

Background and Purpose: No studies have examined clinical decision-making in cerebellar hemorrhages. Clinical and CT features may influence surgery in patients with a spontaneous cerebellar hematoma. One commonly accepted adage is to remove a clot when 3 cm or larger in axial diameter on presentation CT scan. It is possible that certain preferences impact on outcome. Methods: We analyzed 94 patients with spontaneous cerebellar hematomas between the years of 1973–1993. Thirty-one patients underwent suboccipital craniectomy and clot removal with or without ventriculostomy. Deterioration denoted worsening of consciousness, new brainstem signs, or presentation in coma. Statistical analysis was performed utilizing a tree-based model fitted by binary recursive partitioning. Ninety-five percent confidence intervals (CI) were calculated. Results: The overall probability of surgical intervention was 33% (CI 23–43%). The chance of surgery in stable patients was 7% (CI 2–20%). Neurologic deterioration was seen in 54 patients (57%) and increased the prospects of a surgical procedure (52%, CI 38–66%). Surgery was performed in all deteriorating patients with small hematomas (size <3 cm), but large clots (size >3 cm) did not substantially influence surgical decision-making (45%, CI 30–60%) except in patients younger than 70 years old (57%, CI 41–82%). Conclusions: Clinicians at our institution usually wait for clinical deterioration to unfold prior to operating on patients with cerebellar hematomas. After deterioration occurs, they prefer small hematomas but will operate on large hematomas when patients are younger than 70, generally withholding surgery from older patients. These attitudes may impact on outcome and should be considered in future treatment trials.

Predictors of poor outcome in patients with a spontaneous cerebellar hematoma.

The authors studied the clinical and neuroimaging features of cerebellar hematomas to predict poor outcome using comprehensive statistical models. We retrospectively reviewed clinical and neuroimaging features in 94 patients with spontaneous cerebellar hematomas to identify predictive features for a poor neurologic outcome, defined as death or dismissal to long-term care facility. Data were analyzed using chi square and Fisher's exact test with calculation of odd's ratios together with 95% confidence intervals. Clinical and neuroradiologic predictors for a poor outcome at p < 0.05 were admission systolic blood pressure > 200 mm Hg, hematoma size > 3 cm, visible brain stem distortion, and acute hydrocephalus. Presenting findings predicting subsequent death at p < 0.05 were abnormal corneal and oculocephalic responses, Glasgow coma sum score less than 8, motor response less than localization to pain, acute hydrocephalus and intraventricular hemorrhage. A tree-based analysis model using binary recursive partitioning showed that cornea reflex, hydrocephalus, doll's eyes, age, and size were the most important discriminating factors. Absent corneal reflexes on admission highly predicts poor outcome (86 percent, confidence limits 67-96 percent). When a cornea reflex is present, acute hydrocephalus predicts poor outcome but only when doll's eyes are additionally absent.

Hematomas de cerebelo: un ictus con tratamiento quirúrgico

Spontaneous cerebellar hematomas make up nearly 10% of the intracranial intraparenchymatous hemorrhages. In recent years several algorithms have been published for the management of these patients. To study the type of treatment, conservative or operative, and the main prognostic factors. We present a retrospective analysis of 52 cases of spontaneous cerebellar hematomas diagnosed over the past 10 years in the Hospital General de Galicia. We studied the clinical and radiological factors with the greatest effect on prognosis and the approach to treatment. We found a male/female ration of 2/3. The age of 90.3% of our patients was over 60 years. Arterial hypertension had previously been diagnosed in 55.7% of the cases. The clinical picture was characterized by the profile of a stroke with headache (90.3%), vomiting (63.4%) and impaired consciousness (50%) being the commonest presenting symptoms. The most important factors in prognosis were the level of consciousness and the size of the hematoma. The prognosis was worse in cases with hydrocephalus, intraventricular hemorrhage or extension of the hematoma towards the midline. Neither age, sex nor the previous diagnosis of arterial hypertension were of importance in prognosis. Mortality was 25%. The spontaneous cerebellar hematomas typically affect patients over the age of 60 years and present with headache and vomiting of sudden onset. In our series the major prognostic factors were the size of the hematoma and level of consciousness, and treatment was given in accordance with this.

Stereotactic Evacuation and Fibrinolysis of Cerebellar Hematomas

Despite modern diagnostic and operative methods, the mortality and morbidity rates of spontaneous cerebellar hematomas remain very high, i.e., according to a review of the literature as high as 45%. By stereotactic puncture, partial evacuation and fibrinolysis of the remaining hematoma with urokinase, much more favorable results can be achieved. As we could observe in long-term follow-up, only 1 patient out of 15 died within 2 months after operation. The method is effective, easy, exact, without risk and applicable at every age, so that actually there is no comparable alternative way of treatment.

Spontaneous cerebellar hematoma. Analysis of 23 cases

A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of consciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69.5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsatisfactory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.

Spontaneous cerebellar hematoma in children

Spontaneous cerebellar hematoma in children

Spontaneous Cerebellar Hematoma in Children: Report of Two Cases and Review of the Literature

Abstract Two children with hydrocephalus due to a spontaneous intracerebellar hematoma secondary to blood dyscrasia were treated successfully with a ventriculoperitoneal shunt. They represent the first documented cases of spontaneous intracerebellar hemorrhage in children treated successfully without posterior fossa operation. The size of the hematoma. the severity of the hydrocephalus, and the patient's neurological and physical condition are important factors in choosing the mode of treatment.