Traumatic intracerebellar hemorrhage: clinicoradiological analysis of 81 patients.
OBJECTIVE
We report 81 patients with a traumatic intracerebellar hemorrhagic contusion or hematoma managed between 1996 and 1998 at 13 Italian neurosurgical centers.


METHODS
Each center provided data about patients' clinicoradiological findings, management, and outcomes, which were retrospectively reviewed.


RESULTS
A poor result occurred in 36 patients (44.4%). Forty-five patients (55.6%) had favorable results. For the purpose of data analysis, patients were divided into two groups according to their admission Glasgow Coma Scale (GCS) scores. In Group 1 (39/81 cases; GCS score, > or =8), the outcome was favorable in 95% of cases. In Group 2 (42/81 cases; GCS score, <8), the outcome was poor in 81% of cases. Twenty-seven patients underwent posterior fossa surgery. Factors correlating with outcome were GCS score, status of the basal cisterns and the fourth ventricle, associated supratentorial traumatic lesions, mechanism of injury, and intracerebellar clot size. Multivariate analysis showed significant independent prognostic effect only for GCS score (P = 0.000) and the concomitant presence of supratentorial lesions (P = 0.0035).


CONCLUSIONS
This study describes clinicoradiological findings and prognostic factors regarding traumatic cerebellar injury. A general consensus emerged from this analysis that a conservative approach can be considered a viable, safe treatment option for noncomatose patients with intracerebellar clots measuring less than or equal to 3 cm, except when associated with other extradural or subdural posterior fossa focal lesions. Also, a general consensus was reached that surgery should be recommended for all patients with clots larger than 3 cm. The pathogenesis, biomechanics, and optimal management criteria of these rare lesions are still unclear, and larger observational studies are necessary.
d'Avella
Domenico
D
Clinica Neurochirurgica, Policlinico Universitario, Via Consolare Valeria 1, Università di Messina, 98100 Messina, Italy. davellan@unime.it
Servadei
Franco
F
Scerrati
Massimo
M
Tomei
Giustino
G
Brambilla
Gianluigi
G
Angileri
Filippo F
FF
Massaro
Fulvio
F
Cristofori
Luciano
L
Tartara
Fulvio
F
Pozzati
Eugenio
E
Delfini
Roberto
R
Tomasello
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001924:Brain Concussion / Q000000981:diagnostic imaging / Q000601:surgery; D020201:Brain Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000601:surgery; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome