Abstract
Although strategies for managing hypertensive cerebellar hemorrhage are fairly standardized, previous analyses have been limited by the use of univariate statistical methods, such as the chi-square test. We retrospectively examined the functional outcome in patients with hypertensive cerebellar hemorrhage using multivariate statistical analysis, and discuss the therapeutic effectiveness of medical and surgical treatment. Among 96 patients with non-traumatic cerebellar hemorrhage, 87 received a diagnosis of hypertensive cerebellar hemorrhage. Clinical data were available from a total of 81 patients who underwent medical therapy (50 cases) or hematoma evacuation after craniectomy (31 cases). In the medical therapy group, a favorable outcome (good recovery or moderate disability) occurred in 72% (36/50), and multivariate analysis showed that the following variables were significantly associated with a favorable outcome : a score of 14-15 on the Glasgow Coma Scale (GCS) at admission ; a maximum hematoma diameter of less than 4cm ; and patent quadrigeminal cistern on CT scan. In contrast, in the craniectomy group, the rate of favorable outcome was 45% (14/31), and variables significantly associated with a favorable outcome according to multivariate analysis included the following : patent quadrigeminal cistern on CT ; a GCS score of 11-15 on admission ; a maximum hematoma diameter of less than 5 cm ; and absence of intraventricular hematoma in the lateral ventricle. We conclude that hematoma evacuation after craniectomy is indicated in patients with a GCS score of 11 to 13 on admission and a maximum hematoma diameter of less than 5 cm, in order to obtain a favorable outcome (good recovery or moderate disability). At present, however, absence of the quadrigeminal cistern on admission CT predicts a very poor outcome in patients with hypertensive cerebellar hemorrhage, even after craniectomy. Accordingly, we suggest that surgical treatment should be performed immediately if partial compression of the peri-brainstem cistern is seen on CT scan, indicating impending brainstem compression.
