Waidhauser E, Hamburger C, Marguth F
Neurosurgical Department, Ludwig-Maximilian-University Munich, Grosshadern Hospital, West Germany.
Neurosurg Rev. 1990;13(3):211-7. doi: 10.1007/BF00313021.
Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness. Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients. Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.
关于小脑出血患者的治疗仍存在争议。在本研究中，回顾了42例患者的记录。其中60%的患者发现有脑干受压和天幕上疝的体征。发现意识水平与CT扫描上环池的影像学表现一致。环池完全受压总是与昏迷相关，部分受压的环池与昏睡或嗜睡相关，而形态正常的环池与意识水平正常相关。对于有脑干受压和天幕上疝的患者，立即进行后颅窝手术减压可挽救生命。昏迷患者的死亡率为57%，嗜睡或昏睡患者的死亡率为9%。对于仅有脑积水而无脑干受压或天幕疝的病例，单纯脑室造瘘术是首选治疗方法。
