Spontaneous Cerebellar Hemorrhage Research Articles

Cerebellar mutism syndrome caused by bilateral cerebellar hemorrhage in adults: a case report and review of the literature.

Cerebellar mutism syndrome (CMS) is a frequent complication of surgical intervention on posterior fossa in children. It has been only occasionally reported in adults and its features have not been fully characterized. In children and in young adults, medulloblastoma is the main reason for neurosurgery. A single case of postsurgical CMS is presented in an adult patient with a cerebellar hemorrhage and a systematic review of the published individual cases of CMS in adults was done. Literature review of individual cases found 30 patients, 18/30 (60%) males, from 20 to 71years at diagnosis. All but one case was post-surgical, but in one of the post-surgical cases iatrogenic basilar artery occlusion was proposed as cause for CMS. The causes were: primary tumors of the posterior fossa in 16/22 (72.7%) metastasis in 3/30 (10%), ischemia in 3/30 (10%) cerebellar hemorrhage in 3/30 (10%), and benign lesions in 2/30 (6.7%) patients. 8/30 patients (26.7%) were reported as having persistent or incomplete resolution of CMS within 12months. CMS is a rare occurrence in adults and spontaneous cerebellar hemorrhage has been reported in 3/30 (10%) adult patients. The generally accepted hypothesis is that CMS results from bilateral damage to the dentate nucleus or the dentate-rubro-thalamic tract, leading to cerebro-cerebellar diaschisis. Several causes might contribute in adults. The prognosis of CMS is slightly worse in adults than in children, but two thirds of cases show a complete resolution within 6months.

Prognosis of recovery and death within 1–6 months of spontaneous cerebellar hemorrhage undergoing suboccipital craniotomy

BackgroundSuboccipital craniotomy is a considerable surgical approach for large spontaneous cerebellar hemorrhage, but its prognostic has not been comprehensively addressed. This study aims to report the surgical outcomes and factors related to the prognosis of recovery and death within 1–6 months of patients with spontaneous cerebellar hemorrhage MethodsWe retrospectively studied 37 patients who underwent craniotomy due to spontaneous cerebellar hemorrhage from January 2019 to April 2022. ResultsThe disease occurs at a mean age of 62.86 years old, with a male/female ratio of 4.26/1. Hemorrhage is mainly in the cerebellar hemisphere. Hospital stays averaged 13.32 days, with significant reductions in hematoma diameter and volume after surgery. The hospital mortality rate was 5.41 %, increasing to 45.95 % at 1 month post-discharge. Prognostic factors for death within 1 month include low Glasgow score, small hematoma diameter, and low hematoma volume. Factors associated with recovery include young age, absence of ventricle hemorrhage, and high Glasgow score. ConclusionsSuboccipital craniotomy demonstrates a high efficacy in resolving hematomas with decreased complication rates, lower mortality, and improved patient recovery outcomes. Optimal surgical outcomes would be achieved with early intervention, particularly in younger patients.

Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study.

Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH. In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation. We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years. The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.

Surgical evacuation of spontaneous cerebellar hemorrhage: Comparison of safety and efficacy of suboccipital craniotomy and robotic-assisted stereotactic hematoma drainage

ObjectiveThis study compared the efficacies of robotic-assisted stereotactic hematoma drainage and suboccipital craniotomy (SC) in patients with spontaneous cerebellar hemorrhage (SCH). MethodsThis retrospective study included 138 non-comatose patients with SCH (Glasgow Coma Scale score [GCS] >8), divided into the SC and Robotic Stereotactic Assistance (ROSA) groups. The study recorded and analyzed complications and prognoses 90 days after ictus. ResultsThe inclusion criteria were met by 138 patients: 61 in the SC and 77 in the ROSA group, with no significant differences in sex, age, GCS score, hematoma volume, and the time from ictus to operation. The time of operation was greater in the SC group (287.53±87.57) than in the ROSA group (60.54±20.03). The evacuation rate (ER) was greater in the SC group (93.20±1.58) than in the ROSA group (89.13±2.75). The incidence of pneumonia and stress ulcers, as well as the length or costs of medical services, were lower in the ROSA group than in the SC group. Ninety days after ictus, the modified Rankin Scale (mRS), Glasgow Prognostic Scale (GOS), and Karnofsky Performance Scale (KPS) scores significantly differed between the groups. The rate of good prognosis in the ROSA group was significantly higher compared with that in the SC group. The incidence of balance disorders was lower in the ROSA group than in the SC group; no statistically significant difference was found in the incidence of dysarthria and swallowing disorders. ConclusionRobotic-assisted stereotactic hematoma drainage may be suitable for non-comatose and stable condition patients with SCH. This procedure improves prognosis 90 days after ictus, lowers the incidence of pneumonia and stress ulcers, and reduces the length and costs of medical services.

Associated with the 30-Day Outcome of Spontaneous Cerebellar Hemorrhage

Background: Spontaneous cerebellar hemorrhage (SCH) is a potentially life-threatening condition that results in early neurological deterioration, significant disability, and adverse consequences. Therefore, knowledge of the factors that potentially affect the outcome is crucial for a sound clinical decision-making framework and implementing efficient therapeutic measures. Objectives: This study aimed to identify possible clinical, radiological, and therapeutic factors associated with 30-day outcomes in patients with acute SCH. Methods: Sixty-six computerized tomography (CT) diagnosed cases of SCH above 18 years of age who were admitted and managed in the Department of Neurosurgery of Chittagong Medical College Hospital from October 2021 to September 2022 were enrolled prospectively in this study based on inclusion and exclusion criteria. Data regarding demographic, clinical, radiographic, and treatment modalities was recorded. The 30-day outcome was assessed by the Glasgow Outcome Scale (GOS) score and analyzed. A poor outcome was defined by GOS ≤3. Results: The mean age was 65.6±10.8 years and 56.1% were male. The median Glasgow Coma Scale (GCS) score on admission was 13 [interquartile range (IQR) = 8-14]. Twenty-five patients (37.9%) underwent surgical management [evacuation of the cerebellar hemorrhage and placement of an external ventricular drain (EVD) in 7 (28%); EVD alone in 12 (48%), and only evacuation in 6 (24%) cases of surgically managed] and 41 (62.1%) were treated conservatively. The 30 day mortality rate was 36.4%. Regarding 30-day outcomes, 47% (31) of patients had a poor outcome after 30 days. On univariate analysis, GCS score on admission, hematoma size, hematoma volume, ventricular extension, 4th ventricle obstruction, hydrocephalus, tight posterior fossa, ratio between transverse diameter of cerebellar hematoma and posterior fossa, intervention type, and need for mechanical ventilation were significantly associated with 30-day poor outcome. .....

Case Report: Non traumatic Cerebellar Hemorrhage in a Young Man

Intracerebral hemorrhage (ICH) is a seldom-seen event, occurring in around 10% of cases within the cerebellum. These incidents are more common among older adults and are frequently linked to hypertension. However, instances have also been documented in younger individuals, particularly those with arteriovenous malformations and angiomas. The occurrence of spontaneous cerebellar hemorrhages, unrelated to trauma or known risk factors, is exceptionally rare and has a mortality rate ranging from 25% to 57%.
 This case involved a 29-year-old male who experienced a spontaneous cerebellar hemorrhage. Despite being a healthy young adult without common risk factors for cerebrovascular accidents (CVAs), even not smoking.

Association of surgical treatment with functional outcome in patients with spontaneous cerebellar hemorrhage

Objective: To investigate the relation of surgical treatment with patient’s 180-day outcome. Subject and method: Thirty-six patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were treated with operation from January 2017 to March 2022. This study aimed to identify potential clinical and computed tomography (CT) features influencing outcomes after 6 months from ictus, and the association of surgical treatment with SCH patients. Result: The mean age was 62.9 years (IQR 43–83 years). Hypertension was the most common underlying disease (31 patients, 86.1%), followed by smoking (15 patients, 41.7%). 63.9% (23/36) of patients showed loss of consciousness at the initial presentation. Among 36 patients, 25 patients (70%) underwent surgical hemorrhage evacuation with placement of an external ventricle drainage (EVD), 4 patients (10.4%) received an EVD only. The six-moth mortality rate was 33.33%, 12 patients (33.34%) had good outcome (modified Rankin Scale – mRS < 3). In multivariate analysis only the Glasgow coma scale (GCS) score and intracerebral hemorrhage (ICH) score on admission was significant predictor of six-month outcome ([odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.08-2.08, p=0.01; OR = 0.32, CI: 0.10–1.05, p=0.03), respectively. Conclusion: Surgical treatment can be effective for selected patients without lower GSC scores on admission. However, a higher ICH score on admission was associated with a 180-day outcome in patients with SCH.

Spontaneous Hyperventilation Is Common in Patients with Spontaneous Cerebellar Hemorrhage, and Its Severity Is Associated with Outcome.

Background: The spontaneous hyperventilation (SHV) accompanying spontaneous cerebellar hemorrhage has yet to attract a sufficient amount of attention. This study aimed to analyze the incidence of SHV in spontaneous cerebellar hemorrhage patients and its risk factors as well as its association with the outcome. Methods: We retrospectively reviewed the medical records of all spontaneous cerebellar hemorrhage patients who underwent surgical treatment at Tongji Hospital from July 2018 to December 2020. Arterial blood gas (ABG) test results and clinical characteristics, including demographics, comorbidities, imaging features, laboratory tests, and therapy choices, were collected. The Glasgow Outcome Scale was used to assess the outcome at two weeks and six months after admission. Results: A total of 147 patients were included, and of these patients 44.9% had spontaneous hyperventilation. Hypertension (OR, 3.175; CI, 1.332–7.569), usage of sedation drugs (OR, 3.693; CI, 1.0563–8.724), and hypernatremia (OR, 2.803; CI, 1.070–7.340) seemed to positively correlate to SHV occurrence. Hematoma removal had an inverse association with SHV (OR, 0.176; CI, 0.068–0.460). Patients with poor and good outcomes had significant differences in pH, PaCO2, and HCO3− values, and the severity of SHV was associated with the PaCO2 level. Conclusions: Spontaneous hyperventilation is common in patients with spontaneous cerebellar hemorrhage, and its severity is associated with the 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.

Use of the Image Guided Minimally Invasive BrainPath System to Evacuate Spontaneous Cerebellar Hemorrhages.

BrainPath (NICO, Indianapolis, Indiana) is a tool that can be used to evacuate supratentorial hematomas due to spontaneous intracerebral hemorrhage (ICH). However, when ICH occurs in the posterior fossa, an open approach is often undertaken to evacuate the hematoma. The application of minimally invasive technology, while available, has not been well established. Our objective was to describe the use of the image-guided, minimally invasive BrainPath system to evacuate a spontaneous cerebellar hemorrhage. We present the case of a sixty-four-year-old male patient with a cerebellar hematoma due to hypertensive hemorrhage. The patient's medical record, including the history and physical, progress notes, operative notes, discharge summary, and imaging studies were reviewed to document the clinical presentation as well as the details of the operative technique and postoperative outcomes in this paper. We discuss the technical nuances of the operative points in detail. In our example case, the BrainPath system was successfully used to evacuate the cerebellar hematoma and no procedural-related complications occurred. The patient's recovery remained uncomplicated at three months of follow-up. In summary, the BrainPath system offers a less invasive alternative to open evacuation for cerebellar bleeds.

Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage.

The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression. Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P=0.033). In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.

Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage.

PurposePostoperative rebleeding (PRB) is one of the most severe complications after hematoma evacuation of spontaneous intracerebral hemorrhage (ICH). PRB has been proven to be an independent risk factor for poor prognosis. Previous studies have shown that spot sign and blend sign are independent risk factors for PRB of spontaneous ICH. However, the risk factors for PRB of spontaneous cerebellar hemorrhage (SCH) have not been elucidated. The aim of the present study was to investigate the possible risk factors for PRB and short-term prognosis of patients with SCH.Patients and MethodsThis study identified 62 patients with SCH who underwent hematoma evacuation in our department. Risk factors for PRB and short-term prognosis were identified by a univariable logistic regression model, and predictors with a P value of less than 0.05 were included in the multivariable logistic regression model to identify independent predictors. A receiver operating characteristic (ROC) curve was created to test the sensitivity and specificity of independent risk factors.ResultsHematoma volume was the only independent predictor of PRB (OR=15.14, 95% CI=1.08–213.1, P=0.044). The sensitivity and specificity of hematoma volume to PRB were 63.6% and 89.7%, respectively, and the cutoff value of hematoma volume was >29.3 mL. GCS score ≤8 (OR=5.131, 95% CI=1.030–25.554, P=0.046) and PRB (OR=13.17, 95% CI=1.316–131.798, P=0.028) were independent risk factors for poor prognosis of patients with SCH. The sensitivity and specificity of the GCS score to poor prognosis were 66.7% and 86.2%, respectively. The sensitivity and specificity of the PRB to poor prognosis were 36.4% and 96.6%, respectively.ConclusionHematoma volume is likely to be a strong predictor of PRB among patients with SCH. GCS scores ≤8 on arrival and PRB were significant predictors of short-term poor outcome.

Clinical and Radiographic Predictors of Neurological Outcome Following Posterior Fossa Decompression for Spontaneous Cerebellar Hemorrhage

Clinical and Radiographic Predictors of Neurological Outcome Following Posterior Fossa Decompression for Spontaneous Cerebellar Hemorrhage

Deep versus Superficial Spontaneous Cerebellar Hemorrhages: Separated Vascular Etiologies with Different Clinical Consequences

Spontaneous cerebellar hemorrhage (CH) is a critical neurosurgical event. It is usually categorized as a homogenous group under the general term of deep/nonlobar intracerebral hemorrhage. However, increasing evidence suggests it is composed of 2 subgroups, separated from each other by their anatomic location (deep vs. superficial), as well as by their vascular etiology (small vessel disease vs. cerebral amyloid angiopathy). To identify any clinically significant differences between anatomically separated subgroups of CHs: deep versus superficial. This is a retrospective study on patients who were diagnosed with spontaneous CHs at a single tertiary center. On the basis of the radiologic location of the hematoma, patients were divided into 2 groups: deep (group 1) and superficial (group 2). Computerized medical records were extracted for multiple variables. A total of 69 patients fulfilled the inclusion criteria. Fifty-three (77%) were in group 1, and 16 (23%) were in group 2. Having any vascular risk factor was associated with the highest odds ratio for having a deep CH. Morbid obesity (body mass index ≥30) and the use of antiplatelets were also associated with increased odds ratios. Group 1 is also associated with high prevalence of intraventricular hemorrhage, acute hydrocephalus, and less favorable outcome. This study supports the notion that CH is most likely a heterogenous condition, composed of 2 subgroups, separated from each other in terms of anatomic location, vascular etiologies, and clinical consequences. Further studies on large cohort of patients are needed in order to accurately define the subgroups of this life-threatening event.

Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3\xa0cm

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.

Comparison of Long-Term Outcomes of Endoscopic and Minimally Invasive Catheter Evacuation for the Treatment of Spontaneous Cerebellar Hemorrhage

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.

Spontaneous cerebellar hemorrhage carries a grim prognosis in both operated and unoperated patients

Management of spontaneous cerebellar hemorrhage (SCH) has been scarcely reported, and controversies still exist regarding their surgical management. MethodsWe performed a retrospective review of the Rambam Medical Center registry. All cases with a SCH, operated or not, were reviewed. Basic patient parameters, clinical status on admission and imaging results, management and outcome measures were evaluated. Parameters were compared between the operated and unoperated groups, and assessed for their correlation to patient death within 12 months.When operated, patients underwent Suboccipital craniectomy (SOC), insertion of an external ventricular drain (EVD) or both. Results57 patients were treated for SCH in the years 2005–2017. 20 patients (35.09%) died during their original admission. 16 were discharged in non-functional status. In total, 36 patients died within 12 months of their admission. Only 21 patients (36.84%) were alive one year after their bleed.The following parameters were correlated to death in the entire cohort: older age, larger hematoma size, hydrocephalus, brainstem compression by the bleed and outcome status.The unoperated patients were younger, and had a lower Glasgow Coma Scale (GCS) on admission. Death within 12 months occurred in 69.77% of the operated patients, but only 42.86% of the unoperated patients, p = 0.10. Unfavorable outcome was found in 36% of the unoperated group and 72% of the operated group, p = 0.024. ConclusionSCH carries a grim prognosis in both operated and unoperated patients. Roughly one third of patients in our series died during their admission and another third were either vegetative or severely disabled on discharge.

A case of spontaneous cerebellar hemorrhage

A case of spontaneous cerebellar hemorrhage

Spontaneous cerebellar hemorrhage with severe brainstem dysfunction through minimally invasive puncture treatment by locating the simple bedside

This study aims to evaluate the feasibility and effectiveness of minimally invasive puncture treatment by positioning the simple bedside for spontaneous cerebellar hemorrhage.From January 2017 to March 2018, the investigators applied simple bedside positioning to perform the intracranial hematoma minimally invasive surgery for 21 patients with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ± 5.0 cc and 9.5 ± 3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ± 4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ± 0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified Rankin Scale (MRS) score was 2.5 ± 2.0. The postoperative recovery was good. The situation shows that patients with favorable outcomes (MRS score 0–2) accounted for 38.1% (8/21), and the fatality rate was 33.3% (7/21).The efficacy of the intracranial hematoma minimally invasive surgery by positioning the simple bedside for spontaneous cerebellar hemorrhage with severe brainstem dysfunction is good.

Predictive Factors of 2-Year Postoperative Outcomes in Patients with Spontaneous Cerebellar Hemorrhage.

Spontaneous cerebellar hemorrhage (SCH) is associated with high patient mortality and morbidity, but the clinical and radiographic predictors of the postoperative outcome have not been widely addressed in the literature. The purpose of this study was to define the prognostic factors for the two-year postoperative outcome in patients with SCH. We conducted a retrospective study of 48 consecutive patients with SCH who underwent neurosurgical intervention. Correlation analysis was performed to examine the possible link between clinical and radiographic parameters, and the National Institutes of Health Stroke Scale (NIHSS) score at each patient’s discharge and the two-year postoperative outcome as defined according to the Glasgow outcome scale (GOS). A total of 48 patients with SCH underwent neurological surgery, which included suboccipital craniectomy and/or external ventricular drainage (EVD). The mean patient age was 63 years. Nine patients underwent suboccipital craniectomy only; 38 underwent both suboccipital craniectomy and EVD. The overall mortality rate was 35.4%. Fourteen patients (29.2%) had good outcomes. A good outcome on the GOS at 2 years after surgical treatment of SCH was associated with the NIHSS score at discharge. An increase of one point in a patient’s NIHSS score at discharge following neurological surgery will increase the probability of a poor two-year postoperative outcome by 28.5%.