Prognostic factors and long-term outcome following surgical treatment of 76 patients with spontaneous cerebellar haematoma
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Although large spontaneous cerebellar haematomas are associated with high mortality, surgical treatment may be life-saving. We evaluated the clinical outcome and identified prognostic factors in 76 patients with cerebellar haematoma, all treated with suboccipital decompression, haematoma evacuation and external ventricular drainage.
Patients receiving surgical and neurocritical care treatment within a 10-year period were included. Level of consciousness during hospitalisation was evaluated using the Glasgow Coma Scale (GCS) score. Outcome was assessed with the modified Rankin Scale (mRS). Predictive prognostic factors were analysed using univariate and multivariate regression analysis.
Prior to surgery, the median GCS score was 8.6 (range 3–13). At discharge it had improved to 12.1 (4–15) (p < 0.05). The median long-term follow-up period was 70.5 (22–124) months. At 6 months post-surgery, 19 patients were dead and 28 patients had a good outcome (mRS < 3). In the long term (70.5 months), 31 patients (41.9 %) were dead and the outcome was good in 27 patients (37.8 %). Although approximately 25 % of patients >65 years old had a favourable outcome, age was the strongest negative predictor for a bad outcome at 6 months and long term (p = 0.02 and p = 0.01, respectively). The level of consciousness before surgery did not influence the 6-month or long-term outcome (p = 0.39 and p = 0.65, respectively).
Although mortality was high, significant complications from the treatment were rare and most survivors had a good outcome, reaching functional independence. High age was the strongest prognostic factor for an unfavourable outcome.
KeywordsCerebellar haematoma Surgery Decompressive craniectomy Ventriculostomy Outcome Prognostic factors
The study received funds from Uppsala University, the Swedish Stroke Foundation and the Swedish Research Council. The authors would like to thank the NICU staff of Uppsala University Hospital and Mårten Melbius, Department of Neuroradiology, Uppsala University Hospital. Also, Associate Professor Anders Wanhainen, Uppsala University, is thanked for statistical consultation.
Conflicts of interest
- 9.Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV (2001) Management of spontaneous cerebellar hematomas: a prospective treatment protocol. Neurosurgery 49:1378–1386; discussion 1386–1377Google Scholar
- 10.Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A (1994) Treatment of hypertensive cerebellar hemorrhage—surgical or conservative management? Neurosurgery 34:246–250; discussion 250–241Google Scholar