title: Traumatic intracerebellar hemorrhagic contusions and hematomas.
abstract: BACKGROUND
  Traumatic intracerebellar hemorrhagic contusions and hematomas (TIHC) are unusual lesions and their surgical management remains controversial.
  
  
  METHODS
  From January 1990 to July, 1998, 3290 patients underwent computed tomography for acute head trauma at our Institution. Eighteen patients (0.54%) were retrospectively identified as harboring TIHC. Patients were divided into two groups. In Group I (n=78) GCS at admission was > or = 9. Seven patients presented with isolated TIHC and one with an associated supratentorial lesion. Three patients exhibited an evolving clinico-radiological course. In Group II patients (n=10) GCS at admission was < or = 7. All but one presented with severe supratentorial lesions and associated brainstem signs.
  
  
  RESULTS
  In group I six patients had their TIHC managed conservatively, and two were operated on, and all recovered completely. In group II, two patients were operated on. The outcome was poor in 90% of cases.
  
  
  CONCLUSIONS
  TIHC constitute a protean clinico-pathological entity. Non-comatose patients with intracerebellar clots less than 3 cm in diameter should be treated conservatively and expected to make a good recovery. Surgery is indicated for larger hematomas causing cisternal and IV ventricle compression ab initio or as a result of their secondary evolution. In severely ill patients admitted comatose, it is generally the primary brain stem damage and the concomitant severe supratentorial lesions to dictate the prognosis. In these cases obliteration of the posterior fossa cisterns is the most reliable indicator of poor outcome.
authors.affiliation: Department of Neurosurgery, University of Messina School of Medicine, Messina, Italy. davellan@unime.it
authors.forename: D
authors.initials: D
authors.lastname: D'Avella
authors.forename: F
authors.initials: F
authors.lastname: Cacciola
authors.forename: F F
authors.initials: FF
authors.lastname: Angileri
authors.forename: S
authors.initials: S
authors.lastname: Cardali
authors.forename: G
authors.initials: G
authors.lastname: La Rosa
authors.forename: A
authors.initials: A
authors.lastname: Germanò
authors.forename: F
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001933:Brain Stem / Q000098:blood supply / Q000293:injuries / Q000601:surgery; D002531:Cerebellum / Q000098:blood supply* / Q000293:injuries / Q000601:surgery; D020202:Cerebral Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D003388:Cranial Fossa, Posterior / Q000098:blood supply / Q000601:surgery; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome