title: Surgical Management of Moderate Sized Spontaneous Cerebellar Hematomas: Role of Intracranial Pressure Monitoring.
abstract: OBJECTIVE
  Acute onset spontaneous cerebellar hematoma (SCH) is a neurosurgical emergency with unpredictable natural history and outcome. Specific guidelines are available for management of small ( < 2.5 cm) and large sized (4.0 cm < ) SCH. But, literature is sparse for treatment of moderate sized SCH (2.5-4.0 cm).
  
  
  METHODS
  In a retrospective analysis of 32 patients, with moderate sized acute SCH, external ventricular drainage (EVD) tube was inserted for evaluation of ICP and evacuation of cerebrospinal fluid. All patients with ICP > 25 mmHg underwent emergency SCH evacuation. Postoperatively, EVD was continued for 48-72 hours for ICP monitoring. Patients showing no improvement or persistent ventriculomegaly underwent ventriculoperitoneal shunt (VPS) insertion for the management of hydrocephalus.
  
  
  RESULTS
  29/32 patients needed operative intervention either in the form of hematoma evacuation or shunt placement. 10 patients improved to GOS 5 and 7 to GOS 4. Overall mortality was 25% (n=8). Despite SCH evacuation, none of the patients with ICP > 40 mmHg experienced good outcome (p < 0.0001).
  
  
  CONCLUSIONS
  47% of patients with moderate sized SCH need surgical evacuation. EVD insertion not only helps in ICP management but also includes the ability to gradually decompress ventricular system by varying the outflow pressure. Apart from radiologic findings, ICP measurement should be a guideline in management decisions.
authors.affiliation: Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Tewari
authors.forename: Manjul
authors.initials: M
authors.lastname: Tripathi
authors.forename: Rewati Raman
authors.initials: RR
authors.lastname: Sharma
authors.forename: G P
authors.initials: GP
authors.lastname: Mishra
authors.forename: S D
authors.initials: SD
authors.lastname: Lad
mesh_terms: D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000601:surgery*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012189:Retrospective Studies