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Prognostic factors and long-term outcome following surgical treatment of 76 patients with spontaneous cerebellar haematoma

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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References

  1. Chin D, Carney P (1983) Acute cerebellar hemorrhage with brainstem compression in contrast with benign cerebellar hemorrhage. Surg Neurol 19:406–409

    PubMed  Article  CAS  Google Scholar 

  2. Cohen ZR, Ram Z, Knoller N, Peles E, Hadani M (2002) Management and outcome of non-traumatic cerebellar haemorrhage. Cerebrovasc Dis 14:207–213

    PubMed  Article  Google Scholar 

  3. Dammann P, Asgari S, Bassiouni H, Gasser T, Panagiotopoulos V, Gizewski ER, Stolke D, Sure U, Sandalcioglu IE (2011) Spontaneous cerebellar hemorrhage–experience with 57 surgically treated patients and review of the literature. Neurosurg Rev 34:77–86

    PubMed  Article  Google Scholar 

  4. Dolderer S, Kallenberg K, Aschoff A, Schwab S, Schwarz S (2004) Long-term outcome after spontaneous cerebellar haemorrhage. Eur Neurol 52:112–119

    PubMed  Article  Google Scholar 

  5. Dunne JW, Chakera T, Kermode S (1987) Cerebellar haemorrhage–diagnosis and treatment: a study of 75 consecutive cases. Q J Med 64:739–754

    PubMed  CAS  Google Scholar 

  6. Elf K, Nilsson P, Enblad P (2002) Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med 30:2129–2134

    PubMed  Article  Google Scholar 

  7. Gurol ME, St Louis EK (2008) Treatment of cerebellar masses. Curr Treat Options Neurol 10:138–150

    PubMed  Article  Google Scholar 

  8. Heros RC (1982) Cerebellar hemorrhage and infarction. Stroke 13:106–109

    PubMed  Article  CAS  Google Scholar 

  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 1386–1377

    Google 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 250–241

    Google Scholar 

  11. Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR (1985) Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 23:555–558

    PubMed  Article  CAS  Google Scholar 

  12. Mathew P, Teasdale G, Bannan A, Oluoch-Olunya D (1995) Neurosurgical management of cerebellar haematoma and infarct. J Neurol Neurosurg Psychiatry 59:287–292

    PubMed  Article  CAS  Google Scholar 

  13. Melamed N, Satya-Murti S (1984) Cerebellar hemorrhage. A review and reappraisal of benign cases. Arch Neurol 41:425–428

    PubMed  Article  CAS  Google Scholar 

  14. Mezzadri JJ, Otero JM, Ottino CA (1993) Management of 50 spontaneous cerebellar haemorrhages. Importance of obstructive hydrocephalus. Acta Neurochir (Wien) 122:39–44

    Article  CAS  Google Scholar 

  15. Ott KH, Kase CS, Ojemann RG, Mohr JP (1974) Cerebellar hemorrhage: diagnosis and treatment. A review of 56 cases. Arch Neurol 31:160–167

    PubMed  Article  CAS  Google Scholar 

  16. Petridis AK, Barth H, Buhl R, Hugo HH, Mehdorn HM (2008) Outcome of cerebral amyloid angiopathic brain haemorrhage. Acta Neurochir (Wien) 150:889–895

    Article  Google Scholar 

  17. Pollak L, Rabey JM, Gur R, Schiffer J (1998) Indication to surgical management of cerebellar hemorrhage. Clin Neurol Neurosurg 100:99–103

    PubMed  Article  CAS  Google Scholar 

  18. Ryttlefors M, Howells T, Ronne-Engstrom E, Nilsson P, Enblad P (2010) Neurointensive care is justified in elderly patients with severe subarachnoid hemorrhage—an outcome and secondary insults study. Acta Neurochir (Wien) 152:241–249, discussion 249

    Article  Google Scholar 

  19. 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

    Article  CAS  Google Scholar 

  20. Salvati M, Cervoni L, Raco A, Delfini R (2001) Spontaneous cerebellar hemorrhage: clinical remarks on 50 cases. Surg Neurol 55:156–161, discussion 161

    PubMed  Article  CAS  Google Scholar 

  21. Shenkin HA, Zavala M (1982) Cerebellar strokes: mortality, surgical indications, and results of ventricular drainage. Lancet 2:429–432

    PubMed  Article  CAS  Google Scholar 

  22. Skoglund K, Enblad P, Marklund N (2009) Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients. Neurocrit Care 11:135–142

    PubMed  Article  Google Scholar 

  23. 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 27:32–36

    PubMed  CAS  Google Scholar 

  24. Steiner I, Gomori JM, Melamed E (1984) The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma. Stroke 15:279–282

    PubMed  Article  CAS  Google Scholar 

  25. Tamaki T, Kitamura T, Node Y, Teramoto A (2004) Paramedian suboccipital mini-craniectomy for evacuation of spontaneous cerebellar hemorrhage. Neurol Med Chir (Tokyo) 44:578–582, discussion 583

    Article  Google Scholar 

  26. Taneda M, Hayakawa T, Mogami H (1987) Primary cerebellar hemorrhage. Quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 67:545–552

    PubMed  Article  CAS  Google Scholar 

  27. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84

    PubMed  Article  CAS  Google Scholar 

  28. van der Hoop RG, Vermeulen M, van Gijn J (1988) Cerebellar hemorrhage: diagnosis and treatment. Surg Neurol 29:6–10

    PubMed  Article  Google Scholar 

  29. 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) 122:187–193

    Article  Google Scholar 

  30. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    PubMed  Article  Google Scholar 

  31. Waidhauser E, Hamburger C, Marguth F (1990) Neurosurgical management of cerebellar hemorrhage. Neurosurg Rev 13:211–217

    PubMed  Article  CAS  Google Scholar 

  32. Weisberg LA (1986) Acute cerebellar hemorrhage and CT evidence of tight posterior fossa. Neurology 36:858–860

    PubMed  Article  CAS  Google Scholar 

  33. Weisscher N, Vermeulen M, Roos YB, de Haan RJ (2008) What should be defined as good outcome in stroke trials; a modified Rankin score of 0–1 or 0–2? J Neurol 255:867–874

    PubMed  Article  CAS  Google Scholar 

  34. Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, Bone I (2002) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 33:2243–2246

    PubMed  Article  Google Scholar 

  35. Zieger A, Vonofakos D, Steudel WI, Dusterbehn G (1984) Nontraumatic intracerebellar hematomas: prognostic value of volumetric evaluation by computed tomography. Surg Neurol 22:491–494

    PubMed  Article  CAS  Google Scholar 

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Acknowledgements

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.

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Correspondence to Niklas Marklund.

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Tsitsopoulos, P.P., Tobieson, L., Enblad, P. et al. Prognostic factors and long-term outcome following surgical treatment of 76 patients with spontaneous cerebellar haematoma. Acta Neurochir 154, 1189–1195 (2012). https://doi.org/10.1007/s00701-012-1372-7

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  • DOI: https://doi.org/10.1007/s00701-012-1372-7

Keywords

  • Cerebellar haematoma
  • Surgery
  • Decompressive craniectomy
  • Ventriculostomy
  • Outcome
  • Prognostic factors