Neurosurgical Review

, Volume 34, Issue 1, pp 77–86 | Cite as

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

  • Philipp Dammann
  • Siamak Asgari
  • Hischam Bassiouni
  • Thomas Gasser
  • Vassilis Panagiotopoulos
  • Elke R. Gizewski
  • Dietmar Stolke
  • Ulrich Sure
  • I. Erol Sandalcioglu
Original Article


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.


Cerebellar hemorrhage Surgical management Posterior fossa ICH 



  1. 1.
    Heros RC (1982) Cerebellar hemorrhage and infarction. Stroke 13:106–109PubMedGoogle Scholar
  2. 2.
    Da Pian R, Bazzan A, Pasqualin A (1984) Surgical versus medical treatment of spontaneous posterior fossa haematomas: a cooperative study on 205 cases. Neurol Res 6:145–151PubMedGoogle Scholar
  3. 3.
    Dunne JW, Chakera T, Kermode S (1987) Cerebellar haemorrhage—diagnosis and treatment: a study of 75 consecutive cases. Q J Med 64:739–754PubMedGoogle Scholar
  4. 4.
    Freeman RE, Onofrio BM, Okazaki H, Dinapoli RP (1973) Spontaneous intracerebellar hemorrhage. Diagnosis and surgical treatment. Neurology 23:84–90PubMedGoogle Scholar
  5. 5.
    Little JR, Tubman DE, Ethier R (1978) Cerebellar hemorrhage in adults. Diagnosis by computerized tomography. J Neurosurg 48:575–579CrossRefPubMedGoogle Scholar
  6. 6.
    McKissock W, Richardson A, Walsh L (1960) Spontaneous cerebellar haemorrhage: a study of 34 consecutive cases treated surgically. Brain 83:1–9CrossRefGoogle Scholar
  7. 7.
    Dinsdale HB (1964) Spontaneous hemorrhage in the posterior fossa. A study of primary cerebellar and pontine hemorrhages with observations on their pathogenesis. Arch Neurol 10:200–217PubMedGoogle Scholar
  8. 8.
    Ott KH, Kase CS, Ojemann RG, Mohr JP (1974) Cerebellar hemorrhage: diagnosis and treatment. A review of 56 cases. Arch Neurol 31:160–167PubMedGoogle Scholar
  9. 9.
    Brennan RW, Bergland RM (1977) Acute cerebellar hemorrhage. Analysis of clinical findings and outcome in 12 cases. Neurology 27:527–532PubMedGoogle Scholar
  10. 10.
    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 1386-1377CrossRefPubMedGoogle Scholar
  11. 11.
    Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR (1985) Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 23:555–558CrossRefPubMedGoogle Scholar
  12. 12.
    Mathew P, Teasdale G, Bannan A, Oluoch-Olunya D (1995) Neurosurgical management of cerebellar haematoma and infarct. J Neurol Neurosurg Psychiatry 59:287–292CrossRefPubMedGoogle Scholar
  13. 13.
    Auer LM, Auer T, Sayama I (1986) Indications for surgical treatment of cerebellar haemorrhage and infarction. Acta Neurochir (Wien) 79:74–79CrossRefGoogle Scholar
  14. 14.
    Cohen ZR, Ram Z, Knoller N, Peles E, Hadani M (2002) Management and outcome of non-traumatic cerebellar haemorrhage. Cerebrovasc Dis 14:207–213CrossRefPubMedGoogle Scholar
  15. 15.
    Donauer E, Loew F, Faubert C, Alesch F, Schaan M (1994) Prognostic factors in the treatment of cerebellar haemorrhage. Acta Neurochir (Wien) 131:59–66CrossRefGoogle Scholar
  16. 16.
    Firsching R, Huber M, Frowein RA (1991) Cerebellar haemorrhage: management and prognosis. Neurosurg Rev 14:191–194CrossRefPubMedGoogle Scholar
  17. 17.
    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 250-241CrossRefPubMedGoogle Scholar
  18. 18.
    Pollak L, Rabey JM, Gur R, Schiffer J (1998) Indication to surgical management of cerebellar hemorrhage. Clin Neurol Neurosurg 100:99–103CrossRefPubMedGoogle Scholar
  19. 19.
    Salvati M, Cervoni L, Raco A, Delfini R (2001) Spontaneous cerebellar hemorrhage: clinical remarks on 50 cases. Surg Neurol 55:156–161, discussion 161CrossRefPubMedGoogle Scholar
  20. 20.
    Taneda M, Hayakawa T, Mogami H (1987) Primary cerebellar hemorrhage. Quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 67:545–552CrossRefPubMedGoogle Scholar
  21. 21.
    van der Hoop RG, Vermeulen M, van Gijn J (1988) Cerebellar hemorrhage: diagnosis and treatment. Surg Neurol 29:6–10CrossRefPubMedGoogle Scholar
  22. 22.
    van Loon J, Van Calenbergh F, Goffin J, Plets C (1993) Controversies in the management of spontaneous cerebellar haemorrhage. A consecutive series of 49 cases and review of the literature. Acta Neurochir (Wien) 122:187–193CrossRefGoogle Scholar
  23. 23.
    Fisher CM, Picard EH, Polak A, Dalal P, Pojemann RG (1965) Acute hypertensive cerebellar hemorrhage: diagnosis and surgical treatment. J Nerv Ment Dis 140:38–57CrossRefPubMedGoogle Scholar
  24. 24.
    Hess CW, Bassetti C (1994) Neurology of consciousness and of consciousness disorders. Schweiz Rundsch Med Prax 83:212–219PubMedGoogle Scholar
  25. 25.
    Weisberg LA (1986) Acute cerebellar hemorrhage and CT evidence of tight posterior fossa. Neurology 36:858–860PubMedGoogle Scholar
  26. 26.
    Tosteson TD, Buzas JS, Demidenko E, Karagas M (2003) Power and sample size calculations for generalized regression models with covariate measurement error. Stat Med 22:1069–1082CrossRefPubMedGoogle Scholar
  27. 27.
    Wijdicks EF, St Louis EK, Atkinson JD, Li H (2000) Clinician's biases toward surgery in cerebellar hematomas: an analysis of decision-making in 94 patients. Cerebrovasc Dis 10:93–96CrossRefPubMedGoogle Scholar
  28. 28.
    Yoshida S, Kwak S, Saito I, Sano K (1981) Hypertensive cerebellar hemorrhage and cerebellar hemorrhage caused by cryptic angioma: analysis of clinical observations, CT findings and outcome. Neurol Med Chir (Tokyo) 21:735–749CrossRefGoogle Scholar
  29. 29.
    St Louis EK, Wijdicks EF, Li H, Atkinson JD (2000) Predictors of poor outcome in patients with a spontaneous cerebellar hematoma. Can J Neurol Sci 27:32–36PubMedGoogle Scholar
  30. 30.
    Dolderer S, Kallenberg K, Aschoff A, Schwab S, Schwarz S (2004) Long-term outcome after spontaneous cerebellar haemorrhage. Eur Neurol 52:112–119CrossRefPubMedGoogle Scholar
  31. 31.
    Alvarez-Betancourt L, Ramirez-Mendoza A, Lopez-Ortega SJ, Caldera-Duarte A (2005) Spontaneous cerebellar haematoma. Diagnosis, management and follow-up in 18 patients. Gac Méd Méx 141:191–194PubMedGoogle Scholar
  32. 32.
    Koziarski A, Frankiewicz (1991) Medical and surgical treatment of intracerebellar haematomas. Acta Neurochir (Wien) 110:24–28CrossRefGoogle Scholar
  33. 33.
    Mezzadri JJ, Otero JM, Ottino CA (1993) Management of 50 spontaneous cerebellar haemorrhages. Importance of obstructive hydrocephalus. Acta Neurochir (Wien) 122:39–441CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Philipp Dammann
    • 1
  • Siamak Asgari
    • 1
    • 2
  • Hischam Bassiouni
    • 1
    • 3
  • Thomas Gasser
    • 1
  • Vassilis Panagiotopoulos
    • 4
  • Elke R. Gizewski
    • 4
  • Dietmar Stolke
    • 1
  • Ulrich Sure
    • 1
  • I. Erol Sandalcioglu
    • 1
  1. 1.Department of NeurosurgeryUniversity Hospital EssenEssenGermany
  2. 2.Department of NeurosurgeryKlinikum IngolstadtIngolstadtGermany
  3. 3.Department of NeurosurgeryWestpfalz-Klinikum GmbHKaiserslauternGermany
  4. 4.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany

Personalised recommendations