title: Spontaneous cerebellar hemorrhage--experience with 57 surgically treated patients and review of the literature.
abstract: The treatment of spontaneous cerebellar hemorrhage is still discussed controversially. We analyzed a series of 57 patients who underwent surgical evacuation of a cerebellar hematoma at our department. Preoperative clinical and radiological parameters were assessed and correlated with the clinical outcome in order to identify factors with impact on outcome. The overall clinical outcome according to the Glasgow Outcome Scale at the last follow-up was good (GOS 4-5) in 27 patients (47%) and poor (GOS 2-3) in 16 patients (28%). Fourteen patients (25%) died. The initial neurological condition and the level of consciousness proved to be significant factors determining clinical outcome (p = 0.0032 and p = 0.0001, respectively). Among radiological parameters, brain stem compression and a tight posterior fossa solely showed to be predictive for clinical outcome (p = 0.0113 and p = 0.0167, respectively). Overall, our results emphasize the predictive impact of the initial neurological condition on clinical outcome confirming the grave outcome of patients in initially poor state as reported in previous studies. The hematoma size solely, in contrast to previous observations, showed not to be predictive for clinical outcome. Especially for the still disputed treatment of patients in good initial neurological condition, a suggestion can be derived from the present study. Based on the excellent outcome of patients with good initial clinical condition undergoing surgery due to secondary deterioration, we do not recommend preventive evacuation of a cerebellar hematoma in these patients.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. philippdammann@gmx.net
authors.forename: Philipp
authors.initials: P
authors.lastname: Dammann
authors.forename: Siamak
authors.initials: S
authors.lastname: Asgari
authors.forename: Hischam
authors.initials: H
authors.lastname: Bassiouni
authors.forename: Thomas
authors.initials: T
authors.lastname: Gasser
authors.forename: Vassilis
authors.initials: V
authors.lastname: Panagiotopoulos
authors.forename: Elke R
authors.initials: ER
authors.lastname: Gizewski
authors.forename: Dietmar
authors.initials: D
authors.lastname: Stolke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: I Erol
authors.initials: IE
authors.lastname: Sandalcioglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002526:Cerebellar Diseases / Q000601:surgery*; D003399:Craniotomy; D005163:Factor Analysis, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome