Summary
We have reviewed our experience with a series of 49 consecutive patients with spontaneous cerebellar haematoma, treated according to a standardized management protocol. Seventeen patients were managed conservatively, 30 underwent ventricular drainage, and in six patients the haematoma was evacuated. The indications for the different modes of treatment are discussed. The most significant prognostic factors determining the outcome at one month were the grade of quadrigeminal cistern obliteration on the initial CT scan and the Glasgow Coma Scale on admission. Patients with normal cisterns had a good outcome, and only needed (temporary) ventricular drainage in case of hydrocephalus. Patients with totally obliterated cisterns had a bad outcome irrespective of treatment. In the patients with compressed cisterns, it is suggested that evacuation of the haematoma might improve outcome; treatment of hydrocephalus alone is insufficient in many cases in this group.
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References
Acampora S, Guarneri L, Troisi F (1982) Spontaneous intracerebellar haematoma. Report of ten cases. Acta Neurochir (Wien) 66: 83–86
Aoki N, Mizuguchi K (1986) Expanding intracerebellar haematoma: a possible clinicopathological entity. Neurosurgery 1: 94–96
Auer LM, Auer T, Sayama I (1986) Indications for surgical treatment of cerebellar haemorrhage and infarction. Acta Neurochir (Wien) 79: 74–79
Bogousslavsky J, Regli F, Jeanrenaud X (1984) Benign outcome in unoperated large cerebellar haemorrhage. Report of 2 cases. Acta Neurochir (Wien) 73: 59–65
Brennan RW, Bergland RM (1977) Acute cerebellar haemorrhage. Analysis of clinical findings and outcome in 12 cases. Neurology 27: 527–532
Calliauw L, Dehaene I (1980) Cerebellar haematomas. In: Pia HW, Langmaid C, Zierski J (eds) Spontaneous intracerebral haematomas: advances in diagnosis and therapy. Springer, Berlin Heidelberg New York pp 154–155
Chawla JC (1970) Spontaneous intracerebellar haemorrhage. BMJ 1: 93–94
Chin D, Carney P (1983) Acute cerebellar haemorrhage with brainstem compression in contrast with benign cerebellar haemorrhage. Surg Neurol 1: 406–409
Da Pian R, Bazzan A, Pasqualin A (1984) Surgical versus medical treatment of spontaneous posterior fossa haematomas: a cooperative study on 205 cases. Neuro Res 6: 145–151
De Freixo MF, Garcia MJ, Alcelay LG (1979) Cerebellar haemorrhage: nonsurgical forms. Ann Neurol 6: 84
Dinsdale HB (1964) Spontaneous haemorrhage in the posterior fossa. Neurology 1: 200–217
Dunne JW, Chakera T, Kermode S (1987) Cerebellar haemorrhage: diagnosis and treatment. A study of 75 consecutive cases. Q J Med 84: 739–754
Ebeling U, Huber P (1986) Der akute raumfordernde Prozess in der hinteren Schädelgrube. Schweiz Med Wochenschr 116: 1394–1401
Firsching R, Huber M, Frowein RA (1991) Cerebellar haemorrhage: management and prognosis. Neurosurg Rev 14: 191–194
Fisher CM, Picard EH, Polak A, Dalal P, Ojeman RG (1965) Acute hypertensive cerebellar haemorrhage: diagnosis and surgical treatment. J Nerv Ment Dis 140: 38–57
Freeman JW, Kennedy RM, Petty SS (1978) Prognosis of nonoperated cerebellar haemorrhage. Ann Neurol 4: 389–390
Freeman RE, Onofrio BM, Okazaki H, Dinapoli RP (1973) Spontaneous intracerebellar haemorrhage. Diagnosis and surgical treatment. Neurology 23: 84–90
Gerritsen Van Der Hoop R, Vermeulen M, Van Gijn (1988) Cerebellar haemorrhage: diagnosis and treatment. Surg Neurol 29: 6–10
Gilliard C, Mathurin P, Passagia JG, Kallel S, Thauvoy C, Stroobandt G (1990) L'hématome spontané du cervelet. Neurochirurgie 36: 347–353
Greenberg J, Skubick D, Shenkin H (1979) Acute hydrocephalus in cerebellar infarct and haemorrhage. Neurology 29: 409–413
Guillermain P, Lena G, Reynier Y, Vincentelli F, Jazzar A (1990) Hématomes intracérébelleux spontanés de l'adulte. Rev Neurol (Paris) 146: 478–483
Heiman TD, Satya-Murti S (1978) Benign cerebellar haemorrhages. Ann Neurol 3: 366–368
Heros RC (1982) Cerebellar haemorrhage and infarction. Stroke 13: 106–109
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet i: 480–485
Johnson DL, Fitz C, McCullough C, Schwarz S (1986) Perimesencephalic cistern obliteration: a CT sign of life-threatening shunt failure. J Neurosurg 64: 386–389
Kobayashi S, Miyata A, Serizawa T, Otaki M, Nakamura H, Sato A, Watanabe Y (1990) Treatment of cerebellar haemorrhage—surgical or conservative. Stroke [Suppl] 21: 1–61
Koenig A, Laas R, Hermann HD (1987) Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochir (Wien) 88: 104–108
Koziarski A, Frankiewicz E (1991) Medical and surgical treatment of intracerebellar haematomas. Acta Neurochir (Wien) 110: 24–28
Labauge R, Boukobza M, Zinszner J, Blard JM, Pages M, Salvaing P (1983) Hématomes spontanés du cervelet. Vingt-huit observations personnelles. Rev Neurol (Paris) 139: 193–204
Little JR, Tubman DE, Ethier R (1978) Cerebellar haemorrhage in adults. Diagnosis by computerized tomography. J Neurosurg 48: 575–579
Lui T, Fairholm DJ, Shu T, Chang C, Lee S, Chen H (1985) Surgical treatment of spontaneous cerebellar haemorrhage. Surg Neurol 23: 555–558
Marshall LF, Bowers Marshall S, Klauber MR, Van Berkum Clark M, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg [Suppl] 75: S 14-S 20
McKissock W, Richardson A, Walsh L (1960) Spontaneous cerebellar haemorrhage. A study of 34 cases treated surgically. Brain 83: 1–9
Melamed N, Satya-Murti S (1984) Cerebellar haemorrhage. A review and reappraisal of benign cases. Arch Neurol 41: 425–428
Mohadjer M, Eggert R, May J, Mayfrank L (1990) CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar haemorrhage: long-term results. J Neurosurg 73: 217–222
Niizuma H, Suzuki J (1987) Computed tomography-guided stereotactic aspiration of posterior fossa haematomas: a supine lateral retromastoid approach. Neurosurgery 21: 422–427
Norris JW, Eisen AA, Branch CJ (1969) Problems in cerebellar haemorrhage and infarction. Neurology 19: 1043–1050
Ott KH, Kase CS, Ojemann RG, Mohr JP (1974) Cerebellar haemorrhage: diagnosis and treatment. A review of 56 cases. Arch Neurol 31: 160–167
Pozzati E, Nasi MT, Galassi E, Fabrizi A (1986) Benign cerebellar haematomas in children. Childs Nerv Syst 2: 60–62
Richardson AE (1972) Spontaneous cerebellar haemorrhage. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, Vol 12. Vascular diseases of the nervous system, Part II. Elsevier, Amsterdam, pp 54–67
Salazar J, Vaquero J, Martinez P, Santos H, Martinez R, Bravo G (1986) Clinical and CT scan assessment of benign versus fatal spontaneous cerebellar haematomas. Acta Neurochir (Wien) 79: 80–86
Shenkin HA, Zavala M (1982) Cerebellar strokes: mortality, surgical indications, and results of ventricular drainage. Lancet ii: 429–431
Taneda M, Hayakawa T, Mogami H (1987) Primary cerebellar haemorrhage. Quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 67: 545–552
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet ii: 81–84
Theodore WH, Striar J, Burger A (1979) Nonsurgical treatment of cerebellar haematomas. Mt Sinai J Med 46: 328–332
Van Calenbergh F, Goffin J, Plets C (1987) Het spontaan cerebellair haematoom. Recente gegevens omtrent diagnose en behandeling. Tijdschr voor Geneeskunde 43: 721–727
Waidhauser E, Hamburger C, Marguth F (1990) Neurosurgical management of cerebellar haemorrhage. Neurosurg Rev 13: 211–217
Wakai S, Nagai M (1989) Histological verification of microaneurysms as a cause of cerebral haemorrhage in surgical specimens. J Neurol Neurosurg Psychiatry 52: 595–599
Weisberg LA (1986) Acute cerebellar haemorrhage and CT evidence of tight posterior fossa. Neurology 36: 858–860
Zieger A, Vonofakos D, Steudel WI, Dusterbehn G (1984) Nontraumatic intracerebellar haematomas: prognostic value of volumetric evaluation by computed tomography. Surg Neurol 22: 491–494
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van Loon, J., Van Calenbergh, F., Coffin, J. et al. Controversies in the management of spontaneous cerebellar haemorrhage a consecutive series of 49 cases and review of the literature. Acta neurochir 122, 187–193 (1993). https://doi.org/10.1007/BF01405527
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DOI: https://doi.org/10.1007/BF01405527