title: Efficacy and safety of key hole craniotomy for the evacuation of spontaneous cerebellar hemorrhage.
abstract: The efficacy and safety of cerebellar hemorrhage evacuation by key hole craniotomy and the importance of thorough evacuation and irrigation of the hematoma in the fourth ventricle to resolve obstructive hydrocephalus were assessed in 23 patients with spontaneous cerebellar hemorrhage (SCH) greater than 3 cm or with brainstem compression and hydrocephalus. A 5-cm elongated S-shaped scalp incision was made, and a 3-cm key hole craniotomy was performed over a cerebellar convexity area. The hematoma was immediately evacuated through a small corticotomy. The hematoma in the fourth ventricle was gently removed through the hematoma cavity, followed by thorough saline irrigation to release obstructive hydrocephalus. Patients classified retrospectively into favorable and poor outcome groups using the Glasgow Outcome Scale (GOS) scores of 4-5 vs. 1-3 showed significant differences with respect to the preoperative Glasgow Coma Scale, hematoma size and volume, and brainstem compression. Only 2 of the 23 patients required ventricular drainage and no postoperative complications were recorded. Patients treated by experienced and inexperienced surgeons showed no significant differences in the hematoma evacuation rate, postoperative GOS, and interval from skin incision to start of hematoma evacuation. Our simplified method of key hole craniotomy to treat SCH was less invasive but easy to perform, as even inexperienced neurosurgeons could obtain good surgical results. Thorough cleaning of the fourth ventricle minimized the necessity for ventricular drainage.
authors.affiliation: Department of Neurosurgery, Kagoshima University Faculty of Medicine, Kagoshima, Kagoshima, Japan. hiroshitok@nag.bbiq.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokimura
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Tajitsu
authors.forename: Ayumi
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamahata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Kenji
authors.initials: K
authors.lastname: Takayama
authors.forename: Tomomi
authors.initials: T
authors.lastname: Shinsato
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D000368:Aged; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology; D002526:Cerebellar Diseases / Q000209:etiology / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D005260:Female; D020546:Fourth Ventricle / Q000098:blood supply / Q000601:surgery; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome