Advertisement

Neurosurgical Review

, Volume 13, Issue 3, pp 211–217 | Cite as

Neurosurgical management of cerebellar hemorrhage

  • Erich Waidhauser
  • Christoph Hamburger
  • Frank Marguth
Original Articles

Abstract

Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness.

Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients.

Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.

Key words

Ambient cistern cerebellar hemorrhage posterior fossa surgery ventriculostomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Auer LM, Th Auer, I Sayama: Indications for surgical treatment of cerebellar haemorrhage and infarction. Acta Neurochir 79 (1986) 74–79Google Scholar
  2. [2]
    Bogousslavsky J, F Regli, X Jeanrenaud: Benign outcome in unoperated large cerebellar hemorrhage report of 2 cases. Acta Neurochir 73 (1984) 59–65Google Scholar
  3. [3]
    Cuneo RA, JJ Caronna, L Pitts, J Townsend, DP Winestock: Upward transtentorial herniation. Arch Neurol 36 (1979) 618–623Google Scholar
  4. [4]
    Fisher CM, EH Picard, A Polk, P Dalal, RG Ojemann: Acute hypertensive cerebellar hemorrhage. J Nerv Ment Dis 140 (1965) 38–57Google Scholar
  5. [5]
    Gerritsen van der Hoop R, M Vermeulen, J van Gijn: Cerebellar hemorrhage: diagnosis and treatment. Surg Neurol 29 (1988) 6–10Google Scholar
  6. [6]
    Knüpling R, EC Fuchs, G Stoltenburg, G Gerull, M Giesen, D Mrowinski: Chronic and acute transtentorial herniation with tumors of the posterior cranial fossa. Neurochirurgia 22 (1979) 9–17Google Scholar
  7. [7]
    Little JR, DE Tubman, R Ethier: Cerebellar hemorrhage in adults—Diagnosis by computerized tomography. J Neurosurg 48 (1978) 575–579Google Scholar
  8. [8]
    Lui T-N, DJ Fairholm, T-F Shu, C-N Chang, S-T Lee, H-R Chen: Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 23 (1985) 555–558Google Scholar
  9. [9]
    Osborn AG, DK Heaston, SD Wing: Diagnosis of ascending transtentorial herniation by cranial computed tomography. Am J Roentgenol 130 (1978) 755–760Google Scholar
  10. [10]
    Ott KH, CS Kase, RG Ojemann: Cerebellar hemorrhage: Diagnosis and treatment. Arch Neurol 31 (1974) 160–167Google Scholar
  11. [11]
    Plum F, JB Posner: The diagnosis of stupor and coma. FA Davis, Philadelphia 1986Google Scholar
  12. [12]
    Rey-Bellet J: Cerebellar hemorrhage a clinicopathologic study. Neurology 10 (1960) 217–222Google Scholar
  13. [13]
    Salazar J, J Vaquero, P Martinez, H Santos, R Martinez, G Bravo: Clinical and CT scan assessment of benign versus fetal spontaneous cerebellar haematomas. Acta Neurochir 79 (1986) 80–86Google Scholar
  14. [14]
    Taneda M, T Hayakawa, H Mogami: Primary cerebellar hemorrhage. J Neurosurg 67 (1987) 545–552Google Scholar
  15. [15]
    Weisberg LA: Acute cerebellar hemorrhage and CT evidence of tight posterior fossa. Neurology 36 (1986) 858–860Google Scholar

Copyright information

© Walter de Gruyter & Co 1990

Authors and Affiliations

  • Erich Waidhauser
    • 1
  • Christoph Hamburger
    • 1
  • Frank Marguth
    • 1
  1. 1.Neurosurgical Department of the Ludwig-Maximilian-University MunichGroßhadern HospitalMunichWest Germany

Personalised recommendations