Uno M, Shichijo F, Hondo H, Matsumoto K
Department of Neurological Surgery, School of Medicine, University of Tokushima, Japan.
No Shinkei Geka. 1991 Dec;19(12):1121-7.
Patients with severe types of hypertensive cerebellar hemorrhage have been treated usually by suboccipital craniectomy and hematoma evacuation. However, since 1981, we have treated such patients with stereotactic aspiration surgery. The purpose of this study was to evaluate the prognosis of patients treated by stereotactic aspiration surgery for cerebellar hemorrhage in comparison with those who underwent suboccipital craniectomy. Between May 1976 and December 1989, 246 patients with hypertensive cerebellar hemorrhage were admitted to our university hospital and affiliated hospitals. The patients were classified into four categories according to the grading of hypertensive cerebellar hemorrhage proposed by Matsumoto in 1982; benign, moderate, severe, and fulminant. Then we decided the most appropriate therapy according to this grading. Fifty-nine patients (24.0%) underwent suboccipital craniectomy and 38 (15.4%) underwent stereotactic aspiration surgery. There was no significant difference in the postoperative outcome between suboccipital craniectomy and stereotactic aspiration surgery in the overall study. However prognosis of the fulminant type was significantly better with stereotactic aspiration surgery than with suboccipital craniectomy. Possible reasons for this include: 1) All patients of this type who underwent aspiration surgery had this procedure within 12 hours after the onset of cerebellar hemorrhage. 2) The hematoma volume of most patients of this type who had aspiration surgery was under 30ml. 3) The age of all patients of this type with aspiration surgery was under 70 years old. In conclusion, we suggest that aspiration surgery for hypertensive cerebellar hemorrhage is indicated for all patients with moderate, severe and fulminant types of hemorrhage.
重度高血压性小脑出血患者通常采用枕下开颅血肿清除术进行治疗。然而，自1981年以来，我们采用立体定向抽吸手术治疗此类患者。本研究的目的是评估立体定向抽吸手术治疗小脑出血患者与接受枕下开颅手术患者的预后情况。1976年5月至1989年12月期间，246例高血压性小脑出血患者入住我校附属医院。根据松本1982年提出的高血压性小脑出血分级，将患者分为四类：良性、中度、重度和暴发型。然后根据该分级确定最合适的治疗方法。59例（24.0%）患者接受了枕下开颅手术，38例（15.4%）患者接受了立体定向抽吸手术。在整个研究中，枕下开颅手术和立体定向抽吸手术的术后结果无显著差异。然而，暴发型患者采用立体定向抽吸手术的预后明显优于枕下开颅手术。可能的原因包括：1）所有接受抽吸手术的此类患者均在小脑出血发作后12小时内进行了该手术。2）大多数接受抽吸手术的此类患者血肿体积小于30ml。3）所有接受抽吸手术的此类患者年龄均在70岁以下。总之，我们建议对所有中度、重度和暴发型出血的高血压性小脑出血患者进行抽吸手术。
