Morgan Ryan D, Kharbat Abdurrahman F, Youssi Brandon W, Garza John, Nagy Laszlo
School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States.
Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States.
Surg Neurol Int. 2024 Apr 5;15:117. doi: 10.25259/SNI_988_2023. eCollection 2024.
Although uncommon, cerebellar contusions are associated with significant morbidity and mortality. Literature is lacking in the prognostic and morphological factors relating to their clinical picture and outcomes, especially within children. The objective of this study is to evaluate prognostic and anatomic factors in the clinical picture of cerebellar contusions, including effacement of the 4 ventricle and cisterna magna.
This is a retrospective chart review over 11 years across two medical centers. Patients included were under 18 years who presented with a cerebellar contusion. Patients were stratified within the study group based on discharge Glasgow outcome scale (GOS) and reviewed for prognostic factors contributing to outcome. Mid sagittal area of the 4 ventricle and cisterna magna were measured using magnetic resonance imaging and compared within the groups.
A total of 21 patients met the study criteria, of which 16 (76.2%) were male, with an average patient age of 8.65 years. Poor outcome at discharge (GOS <4) was associated with decreased admission Glasgow coma scale ( = 0.003), admission motor response ( = 0.006), pupil reactivity ( = 0.014), presence of concomitant subarachnoid hemorrhage ( = 0.010), contusion volume ( < 0.001), and decreased area of the cisterna magna ( = 0.012). Patients with poor outcomes were also more likely to require surgical intervention ( = 0.042).
There are multiple prognostic factors associated with the overall outcome following cerebellar contusions. The rate of good outcomes in this study was superior to that in previous studies in adults.
尽管小脑挫伤并不常见，但却与显著的发病率和死亡率相关。关于其临床症状及预后的预后因素和形态学因素的文献较少，尤其是在儿童中。本研究的目的是评估小脑挫伤临床症状中的预后因素和解剖学因素，包括第四脑室和小脑延髓池的受压情况。
这是一项对两个医疗中心11年间病例的回顾性研究。纳入的患者为18岁以下的小脑挫伤患者。根据出院时的格拉斯哥预后量表（GOS）对研究组患者进行分层，并对影响预后的因素进行分析。使用磁共振成像测量第四脑室和小脑延髓池的矢状面中部面积，并在各组之间进行比较。
共有21例患者符合研究标准，其中16例（76.2%）为男性，患者平均年龄为8.65岁。出院时预后不良（GOS<4）与入院时格拉斯哥昏迷量表评分降低（=0.003）、入院时运动反应（=0.006）、瞳孔反应性（=0.014）、合并蛛网膜下腔出血（=0.010）、挫伤体积（<0.001）以及小脑延髓池面积减小（=0.012）有关。预后不良的患者也更有可能需要手术干预（=0.042）。
小脑挫伤后的总体预后有多个预后因素。本研究中的良好预后率高于先前关于成人的研究。
