Spontaneous cerebellar hemorrhage: Clinical remarks on 50 cases

BACKGROUND Only during the past 10 years have spontaneous cerebellar hemorrhages becam e a well-defined nosological entity. The surgical indication remeins debata ble. Our primary objective in this study was to set the criteria for undert aking surgery by determining the critical diameter of the hematoma and cons idering the patients' neurological status (Glasgow Coma Scale). METHODS During the 8-year period 1990 through 1997 a series of 50 consecutive patie nts with spontaneous cerebellar hemorrhage were admitted to the Emergency N eurosurgery Unit, University of Rome "La Sapienza" (Italy). On admission al l patients underwent a standard neurological examination, (Glasgow Coma Sca le) and a computed tomographic scan. The diameter and the site of the hemat oma, a coexisting tight posterior fossa, and the presence of hypertensive h ydrocephalus were the criteria, in association with the patients' neurologi cal status, used as indications for surgery. RESULTS Operative mortality was nil; and perioperative mortality eight patients (16 %, increasing to 24% including the four patients who were deeply comatose o n admission). Most patients who died (seven of eight) had two or more gener al medical risk factors (arterial hypertension and diabetes mellitus; arter ial hypertension and liver disease; or liver disease and hematological diso rders). CONCLUSION In patients presenting with spontaneous cerebellar hemorrhage the essential criteria indicating surgery are a hematoma 40 mm x 30 mm on CT imaging in the cerebellar hemisphere or 35 mm x 25 mm on CT imaging in the vermis, the presence of a tight posterior fossa (critical size reduced by 10 mm), and a Glasgow Coma Score less than 13. (C) 2001 by Elsevier Science Inc.