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[Emergency manual aspiration for severe hypertensive cerebellar hemorrhage]
H Nakashima1, M Shigemori, T Kikuchi
1Department of Neurosurgery, Kurume University School of Medicine.
Insights
Manual aspiration for cerebellar hemorrhage showed better outcomes than suboccipital craniectomy, especially in deep coma patients. Prompt surgical intervention is crucial for improving patient prognosis.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Hypertensive cerebellar hemorrhage is a severe neurological condition often leading to coma.
- Surgical intervention is critical for managing cerebellar hematomas and improving patient outcomes.
- Comparing different surgical techniques is essential for optimizing treatment strategies.
Purpose of the Study:
- To compare the effectiveness of manual aspiration versus suboccipital craniectomy for hypertensive cerebellar hemorrhage.
- To evaluate the impact of surgical timing and hematoma volume on patient outcomes.
- To determine the optimal surgical approach for patients with cerebellar hemorrhage and varying levels of consciousness.
Main Methods:
- A retrospective study of 16 patients with hypertensive cerebellar hemorrhage and coma or deep coma.
- Patients were divided into two groups: manual aspiration (9 patients) and suboccipital craniectomy (7 patients).
- Outcomes were assessed based on neurological recovery, with specific attention to the duration from admission to operation and hematoma volume.
Main Results:
- Manual aspiration resulted in a good outcome for 55.6% of patients, including 40% of those in deep coma.
- Suboccipital craniectomy yielded a good outcome for only 28.6% of patients, with poor recovery in all deep coma cases.
- Shorter intervals from admission to operation and smaller hematoma volumes (under 30 ml) were associated with better outcomes.
Conclusions:
- Manual aspiration appears to be a more effective surgical technique for hypertensive cerebellar hemorrhage compared to suboccipital craniectomy, particularly in deep coma patients.
- The time to surgical intervention is a critical factor influencing patient prognosis.
- Hematoma volume exceeding 30 ml is a significant predictor of poor outcomes, underscoring the need for timely and efficient hematoma evacuation.
Abstract:
We treated 16 patients with hypertensive cerebellar hemorrhage and coma, or deep coma. Their ages ranged from 44 to 79 years (mean age: 66.3 years). Manual aspiration was performed in 9 patients and suboccipital craniectomy was performed in 7 patients. The difference in outcome between the manual aspiration group and the suboccipital craniectomy group with severe hypertensive cerebellar hemorrhage was then evaluated. Manual aspiration was performed for 4 patients in coma, and 5 in deep coma, with a mean age of 69.0 years. The average size of the hematoma was 48.7mm and the mean volume was 31. 7ml on CT scan. The mean interval from admission to operation was about 60 minutes. The mean aspiration rate was 79.6% and 7 patients (77.8%) had a good response to drainage. The suboccipital craniectomy patients included 5 in coma, and 2 in deep coma, with a mean age of 63.4 years. The average size of the hematoma was 51.1 mm and the mean volume was 33.1 ml on CT scan. The mean interval from admission to operation was about 112 minutes and the mean evacuation rate was 86.4%. The results were as follows: 1) After manual aspiration, 5 patients (55.6%) had a good outcome and 2 patients (40%) with deep coma showed good recovery. In contrast, after suboccipital craniectomy only 2 patients (28.6%) had a good outcome and all of the deep coma patients showed poor recovery. 2) The outcome may be most strongly influenced by the duration from admission to operation. 3) All patients with a hematoma volume of over 30 ml had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)