Mohadjer M, Eggert R, May J, Mayfrank L
Department of Stereotactic Neurosurgery, University of Freiburg Medical School, Federal Republic of Germany.
J Neurosurg. 1990 Aug;73(2):217-22. doi: 10.3171/jns.1990.73.2.0217.
The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.
自发性小脑出血的手术指征不像颅内出血的手术治疗那样存在争议。手术时机至关重要：干预过早会给患者带来额外负担并增加风险，而等待太久才清除血肿可能是致命的。这种困境可能是文献报道的手术治疗和保守治疗后相对较高的死亡率和发病率（分别为42.5%和30%）的一个因素。在对14例患者的长期研究中，作者表明，立体定向穿刺和纤维蛋白溶解术治疗小脑出血是目前所用治疗方法的一种有价值的替代方法。该方法包括计算机断层扫描（CT）引导下的立体定向穿刺和血肿部分清除。在用尿激酶进行纤维蛋白溶解后，可通过插入血肿腔内的导管将残余血肿完全清除。14例患者中只有1例在术后直接阶段死亡；其余患者在急性事件发生6个月后生活质量良好至非常好。两名患者随后分别因肺炎和脑梗死死亡；这两种情况均与出血无关。作者得出结论，CT引导下的立体定向方法简单、有效且安全，可应用于任何年龄的患者。
