Van Calenbergh F, Van Havenbergh T, Goffin J, Plets C
Service de Neurochirurgie, Hôpital Universitaire Gasthuisberg, Katholieke Universiteit, Leuven, Belgique.
Neurochirurgie. 1996;42(3):162-7; discussion 167-8.
We present a retrospective analysis of a consecutive series of 50 patients, over 60 years of age, with spontaneous cerebellar hematomas. Treatment was chosen on an individual basis : conservative treatment in 8 "benign" cases, craniotomy and/or ventricular drainage in the majority of cases (37), depending on the clinical presentation and the degree of hydrocephalus on CT scan, and surgical abstention in 5 moribund patients. The outcome at one month was studied and compared for different possible prognostic factors. Seventeen patients (34%) died, and three were in a vegetative state; they later died as a direct result of their initial cerebellar hemorrhage. At the latest follow-up, five other patients had also died, one due to cancer, and the others from cardiac causes. The obliteration of the basal cisterns, the volume of the hematoma, the absence of brain stem reflexes and the presence of coma were highly significant factors determining early mortality. The age of the patients, their estimated premorbid health and the degree of hydrocephalus were not significantly associated with fatal outcome. Intensive treatment for cerebellar hematomas, including suboccipital craniotomy, may be justified even in aged patients after careful selection.
