Acta Neurochirurgica

, Volume 79, Issue 2–4, pp 74–79 | Cite as

Indications for surgical treatment of cerebellar haemorrhage and infarction

  • L. M. Auer
  • Th. Auer
  • I. Sayama


This report summarizes the outcome of 56 patients with cerebellar lesions of vascular origin, 40 patients with cerebellar infarction, and 16 with spontaneous cerebellar haemorrhage. All patients had computerized tomography: occlusive hydrocephalus was diagnosed in 75% of patients with cerebellar haemorrhage and in 23% with cerebellar infarction.

Nine out of 10 patients survived after early surgical evacuation of the haematoma and 4 of them recovered completely. Two patients underwent only external ventricular drainage (EVD), one died after 2 days, and the other recovered with a moderate deficit. Three of 4 medically treated patients died within one week; all had developed occlusive hydrocephalus. The fourth medically treated patient recovered completely; consciousness had never deteriorated nor had occlusive hydrocephalus developed.

Among 40 patients with cerebellar infarction, 13 developed progressive deterioration of consciousness; 7 of them underwent decompressive craniectomy of the posterior fossa and survived. One patient had only external ventricular drainage and died. Four out of the 5 medically treated patients died during the acute phase.

From these observations and several reports in the literature, it is concluded that both cerebellar haemorrhage and infarction should be operated on as soon as progressive deterioration of consciousness develops. This occurs more frequently in patients with cerebellar haemorrhage than with cerebellar infarction. Individual decisionmaking in each case necessiates intensive neurosurgical observation.


Computerize Tomography Acute Phase Hydrocephalus Interventional Radiology Posterior Fossa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Auer, L. M., Endoscopic evacuation of intracerebral haemorrhage. High-tec-surgical treatment-a new approach to the problem? Acta Neurochir. (Wien)74 (1985), 124–128.Google Scholar
  2. 2.
    Bogousslavsky, J., Regli, F., Jeanrenaud, X., Benign outcome in unoperated large cerebellar haemorrhage. Report of 2 cases. Acta Neurochir. (Wien)73 (1984), 59–65.Google Scholar
  3. 3.
    Brennan, R. W., Bergland, R. M., Acute cerebellar hemorrhage: Analysis of clinical findings and outcome in 12 cases. Neurology27 (1977), 527–532.PubMedGoogle Scholar
  4. 4.
    Cioffi, F. A., Bernini, F. P., Punzo, A., D'Avanzo, R., Surgical management of acute cerebellar infarction. Acta Neurochir. (Wien)74 (1985), 105–122.Google Scholar
  5. 5.
    Da Pian, R., Bazzan, A., Pasqualin, A., Surgical versus medical treatment of spontaneous posterior fossa hematomas: A cooperative study on 205 cases. In: Abstractbook of the 7th European Congress of Neurosurgery, Brussels 1983 (Brihaye, J., Vigouroux, R., Achslogh, J., Calliauw, L., eds.), p. 96.Google Scholar
  6. 6.
    Duncan, G. W., Parker, S. W., Fisher, C. M., Acute cerebellar infarction in the PICA territory. Arch. Neurol. (Chicago)32 (1975), 364–368.Google Scholar
  7. 7.
    Fairburn, B., Oliver, L. C., Cerebellar softening. A surgical emergency. Br. Med. J.1 (1956), 1335–1336.Google Scholar
  8. 8.
    Feely, M. P., Cerebellar infarction. Neurosurgery4 (1979), 7–11.PubMedGoogle Scholar
  9. 9.
    Fisher, C. M., Karnes, W. E., Kubik, C. S., Lateral medullary infarction—the pattern of vascular occlusion. J. Neuropath. exp. Neurol.29 (1961), 323–379.Google Scholar
  10. 10.
    Fisher, C. M., Picard, E. H., Polak, A., Dalal, P., Ojemann, R. G., Acute hypertensive cerebellar hemorrhage: Diagnosis and surgical treatment. J. Nerv. Ment. Dis.140 (1965), 38–57.PubMedGoogle Scholar
  11. 11.
    Geraud, G., Guillame, J., Lagarrique, J.,et al., Les ramollissements pseudotumoraux du cervalet. Rev. Neurol. (Paris)3–134 (1978), 183–195.Google Scholar
  12. 12.
    Greenberg, J., Shubick, D., Shenkin, H., Acute hydrocephalus in cerebellar infarct and hemorrhage. Neurology11 (1961), 697–700.Google Scholar
  13. 13.
    Heros, R. C., Cerebellar infarction resulting from traumatic occlusion of a vertebral artery: Case report. J. Neurosurg.51 (1979), 111–113.PubMedGoogle Scholar
  14. 14.
    Heros, R. C., Cerebellar hemorrhage and infarction. Stroke12 (1981), 17–22.PubMedGoogle Scholar
  15. 15.
    Heros, R. C., Cerebellar hemorrhage and infarction. Stroke13 (1982), 106–109.PubMedGoogle Scholar
  16. 16.
    Khan, M., Polyzoidis, K. S., Adegbite, A. B. O., McQueen, J. D., Massive cerebellar infarction: “Conservative” management. Stroke14 (1983), 745–751.PubMedGoogle Scholar
  17. 17.
    Laun, A., Busse, O., Calatayud, V., Klug, N., Cerebellar infarcts in the area of the supply of the PICA and their surgical treatment. Acta Neurochir. (Wien)71 (1984), 295–306.Google Scholar
  18. 18.
    Lehrich, J. R., Winkler, G. F., Ojemann, R. G., Cerebellar infarction with brain stem compression: Diagnosis and surgical treatment. Arch. Neurol. (Chicago)22 (1970), 490–498.Google Scholar
  19. 19.
    Lindgren, S. O., Infarctions simulating brain tumours in the posterior fossa. J. Neurosurg.13 (1965), 575–581.Google Scholar
  20. 20.
    McKissock, W., Richardson, A., Walsh, L., Spontaneous cerebellar hemorrhage. A study of 34 consecutive cases treated surgically. Brain83 (1960), 1–9.Google Scholar
  21. 21.
    Mikabe, T., Tomita, S., Kim, H., Karasawa, H., Watanabe,.S., Ueno, J., Oya, S., Surgical indication in hypertensive cerebellar hemorrhage. In: Abstractbook of the 7th European Congress of Neurosurgery, Brussels 1983 (Brihaye, J., Vigouroux, R., Achslogh, J., Calliauw, L., eds.), p. 96.Google Scholar
  22. 22.
    Momose, K. J., Lehrich, J. R., Acute cerebellar infarction presenting as a posterior fossa mass. Radiology109 (1973), 343–352.PubMedGoogle Scholar
  23. 23.
    Norris, J. W., Eisen, A. A., Branch, C. L., Problems in cerebellar hemorrhage and infarction. Neurology19 (1969), 1043–1050.PubMedGoogle Scholar
  24. 24.
    Ojemann, R. G., Heros, R. C., Spontaneous brain hemorrhage. Stroke14 (1983), 468–475.PubMedGoogle Scholar
  25. 25.
    Ott, K. H., Kase, C. S., Ojemann, R. G., Mohr, J. P., Cerebellar hemorrhage: Diagnosis and treatment: A review of 56 cases. Arch. Neurol.31 (1974), 160–167.PubMedGoogle Scholar
  26. 26.
    Richardson, A. E., Spontaneous cerebellar hemorrhage. In: Handbook of Clinical Neurology, Vol. 12 (Vinken, P. J., Bruyn, G. W., eds.), pp. 54–67. Amsterdam: North Holland Publishing Co. 1972.Google Scholar
  27. 27.
    Rosenberg, G. A., Kaufmann, D. M., Cerebellar hemorrhage; Reliability of clinical evaluation. Stroke7 (1976), 332–336.PubMedGoogle Scholar
  28. 28.
    Sayama, I., Auer, L. M., Ladurner, G., Schneider, G., Ischemic edema in cerebellar infarction causing brainstem compression. In: Recent Progress in the Study and Therapy of Brain Edema (Go, K. G., Baethmann, A., eds.), pp. 701–710. New York-London: Plenum Press. 1984.Google Scholar
  29. 29.
    Shenkin, H. A., Zavala, M., Cerebellar strokes: Mortality, surgical indications, and results of ventricular drainage. Lancet2 (1982), 429–432.PubMedGoogle Scholar
  30. 30.
    Sypert, G. W., Alvord, E. C., Jr., Cerebellar infarction: A clinicaopathological study. Arch. Neurol. (Chicago)32 (1975), 357–363.Google Scholar
  31. 31.
    Sypert, G. W., Cerebellar hemorrhage and infarction. Comprehensive Ther.3 (1977), 42–47.Google Scholar
  32. 32.
    Yoshida, S., Sasaki, M., Oka, H., Gotoh, O., Yamada, R., Sano, K., Acute hypertensive cerebellar hemorrhage with signs of lower brainstem compression. Surg. Neurol.10 (1978), 79–83.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • L. M. Auer
    • 1
    • 2
  • Th. Auer
    • 1
    • 2
  • I. Sayama
    • 1
    • 2
  1. 1.Department of NeurosurgeryGraz UniversityAustria
  2. 2.Division of Surgical NeurologyResearch Institute of Brain and Blood VesselsAkitaJapan

Personalised recommendations