V.G. Dashyan, A.A. Murashko
Faculty of Neurosurgery of Moscow State Medical-Stomatologic University, Moscow, Russia
Sklifosovsky Research Institute of Emergency care, Moscow, Russia
The study goal has been more precise estimation of treatment of hypertensive cerebellar hematomas (HCH).
Material and Methods. There were 34 males (61%) and 22 females (39%) with HCH, whose volume varied from 0.5 up to 41 cm3. The analysis of their treatment was carried out. Ventricular hemorrhage (VH) and occlusive hydrocephalus (OH) were present in 26 (46%) and 21 (38%) cases, respectively.
Results and Discussion. A state severity was conditioned by a tempo of disease development, presence of stem symptoms, a hematoma volume (13.5 cm3 and more), stroke localization within a vermis, VH, OH, stem dislocation (p<0.05). Risk factors, determining negative dynamics of a neurological state, included a state severity, characterized by a score of 5 and more (the Stroke Scale); presence of stem symptoms; HCH volume of 13 cm3 and more; OH; stem dislocation; VH; age of 53 and more (p<0.05). Stem dislocation was watched in hematomas with a volume of 14 cm3 and more (p<0.0001). Operations were performed in 36 cases with HCH, compressing the stem and causing OH. Good restoration, moderate and gross invalidism were watched in 11 (31%), 11 (31%) and 1 (2%) cases, respectively. There were 13 (36%) fatal outcomes. Operations were not made in 20 cases; 2 of them died (10%). The score, describing their state severity, was 7 and 30 (the Stroke Scale). These 2 cases had hematomas of the vermis (13.5 and 41 cm3), compressing the stem and accompanied by OH and VH (2.7 and 12 cm3, respectively).
Conclusion. Neurosurgical treatment is not indicated in cases with hematomas of the vermis of less than 13 cm3, as well as without stem compression and occlusive hydrocephalus. In case of hematomas of less than 14 cm3, absence of stem compression and presence of acute occlusive hydrocephalus, it is indicated to apply external ventricular drainage. Hemorrhages of 14 cm3 and more, compressing the stem, should be removed.