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Spontaneous cerebellar hemorrhage—experience with 57 surgically treated patients and review of the literature

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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.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Philipp Dammann, Siamak Asgari, Hischam Bassiouni, Thomas Gasser, Dietmar Stolke, Ulrich Sure & I. Erol Sandalcioglu

  2. Department of Neurosurgery, Klinikum Ingolstadt, Ingolstadt, Germany

    Siamak Asgari

  3. Department of Neurosurgery, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany

    Hischam Bassiouni

  4. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

    Vassilis Panagiotopoulos & Elke R. Gizewski

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  1. Philipp Dammann
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  2. Siamak Asgari
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  8. Ulrich Sure
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  9. I. Erol Sandalcioglu
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Correspondence to Philipp Dammann.

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Comments

Jan-Karl Burkhardt, Zurich, Switzerland

Dammann et al. present a retrospective analysis about their experiences with surgically treated spontaneous cerebellar hemorrhages in 57 cases. Lesions located in the posterior fossa, in particular spontaneous hemorrhages, are still challenging for neurosurgeons in charge of patient’s treatment and indication for surgery is discussed controversial in literature. The authors nicely summarize the current literature and discuss their surgical experiences with regard to present guidelines in this field. Based on this findings, Dammann et al. reveal recommendations for the indication of surgery based on an accurately analysis of the initial neurological condition to achieve the best patient outcome. Here, it would be interesting to see the results of surgically treated patients in direct comparison to a patient group treated without any surgical intervention. In summary, this serial is one of the largest in literature and adds perfectly as an important contribution to the body of literature in this field.

Jack Jallo, Philadelphia, USA

The authors present a series of 57 patients with spontaneous cerebellar hemorrhages and describe their outcomes after surgical evacuation and the factors associated with outcome. Outcomes were described using the Glasgow Outcome Scale and were obtained at discharge and at a mean of 34 months. The authors note that outcome is significantly associated with initial neurologic condition and not hematoma size. This is in contrast to the observations of others. A limitation of this study is that it is a retrospective review of patient records. Despite this, an important observation is presented by this paper: Neurologic presentation is more important than hematoma size in determining outcome.

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Dammann, P., Asgari, S., Bassiouni, H. et al. Spontaneous cerebellar hemorrhage—experience with 57 surgically treated patients and review of the literature. Neurosurg Rev 34, 77–86 (2011). https://doi.org/10.1007/s10143-010-0279-0

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  • DOI: https://doi.org/10.1007/s10143-010-0279-0

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