Surgical Evacuation of Spontaneous Cerebellar Hemorrhage: Comparison of Safety and Efficacy of Suboccipital Craniotomy, Stereotactic Aspiration, and Thrombolysis and Endoscopic Surgery

• Published in: World neurosurgery 2018-09, Vol.117, p.e90-e98
• Main Authors: Li, Lihong, Li, Zhihong, Li, Yuqian, Su, Rujuan, Wang, Bao, Gao, Li, Yang, Yanlong, Xu, Feifei, Zhang, Xi, Tian, Qiang, Zhang, Xingye, Guo, Qingbao, Chang, Tao, Luo, Tao, Qu, Yan
• Format: Article
• Language: English
• Subjects: Endoscopy; Modified Rankin Scale; Spontaneous intracerebellar hemorrhage; Stereotactic aspiration and thrombolysis; Suboccipital craniotomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.170

Current surgical therapies for spontaneous intracerebellar hemorrhage (SCH) include suboccipital craniotomy (SC), stereotactic aspiration and thrombolysis (SAT), and endoscopic surgery (ES). Evidence comparing the therapeutic effects of these 3 methods is scarce. The safety and efficacy of SC, SAT, and ES for SCH are still uncertain. 75 patients with SCH who received SC, SAT, or ES were reviewed retrospectively. Baseline parameters before the operation, evacuation rate, perihematoma edema, postoperative complications, and cumulative case fatalities were collected. Also, 12 months after ictus, the long-term functional outcomes in patients with regard to fourth ventricle compression and age were judged, respectively, by the modified Rankin Scale (mRS). The SAT was less effective in evacuating hematoma than were SC and ES. The perihematoma edema on postoperative day 7 and surgical complications were highest in the SC group. The functional outcome represented by mRS was better in the SAT group than in the SC and ES groups for patients with fourth ventricle compression grade 1. For patients with fourth ventricle compression grades 2 and 3, the ES group achieved the best functional outcome. Patients older than 60 years benefited less from SC than from ES and SAT. SAT may be suitable for SCH patients with fourth ventricle compression grade 1, and ES may be suitable for SCH patients with fourth ventricle compression grades 2 and 3. Aged patients benefit less from SC than from SAT and ES. •SAT was less effective in evacuating hematoma than were SC and ES.•The functional outcomes were the best in the SAT group for patients with grade 1 fourth ventricle compression.•For patients with grades 2 and 3 fourth ventricle compression, the ES group achieved the best functional outcome.•Patients older than 60 years benefited less from SC than from ES and SAT.