title: Does suboccipital decompression and evacuation of intraparenchymal hematoma improve neurological outcome in patients with spontaneous cerebellar hemorrhage?
abstract: OBJECTIVE
  Spontaneous cerebellar hemorrhages (SCH) can lead to life-threatening complications with high mortality rates of 20-50%. Although complications of SCH can be prevented by surgical therapy, there is a lack of consensus concerning the optimal surgical technique for evacuating SCH.
  
  
  METHODS
  In this retrospective study 85 patients with SCH were divided into four treatment groups: (1) Decompression and Hematoma Evacuation via suboccipital craniectomy and removal of the posterior arch of C1 (DHE). (2) Hematoma Evacuation Only via craniotomy (HEO). (3) External Ventricular Drainage (EVD). (4) Conservative treatment (C). To ascertain the level of consciousness, Glasgow Coma Scale (GCS) was calculated. To evaluate the clinical and neurological outcome, modified Rankin Score, Glasgow Outcome Scale and mortality rate were recorded after 6months.
  
  
  RESULTS
  The mean volume of hematoma was significant larger in the DHE- and HEO-group compared to the EVD- and C-group before treatment. DHE and HEO could significantly reduce the volume comparing pre- and postoperative measurements. Larger preoperative volume was a strong predictor of worse neurological outcome and high mortality. Overall mortality was 25.9%. After subdivision into the treatment groups, a comparison of the DHE- and HEO-groups showed a trend towards lower mortality and better neurological outcome in the DHE-group. Patients with the worst preoperative GCS scores profited significantly from DHE with respect to regaining consciousness.
  
  
  CONCLUSIONS
  Patients with SCH should receive surgical therapy when hemorrhages are space-occupying and when the patient's neurological condition deteriorates. With regards to surgical technique, and limited by the retrospective design of the study, our results indicate that patients might benefit most from DHE.
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Germany.
authors.forename: Katharina A M
authors.initials: KA
authors.lastname: Hackenberg
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Germany.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Unterberg
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Germany.
authors.forename: Carla S
authors.initials: CS
authors.lastname: Jung
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schönenberger
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Germany. Electronic address: klaus.zweckberger@med.uni-heidelberg.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Zweckberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D023261:Glasgow Outcome Scale; D006406:Hematoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cerebellar hemorrhage; Neurological outcome; Suboccipital decompression