Traumatic intracerebellar haematoma: To operate or not to operate?

Pure cerebellar haematoma of traumatic etiology, without associated posterior fossa sub- or epi-dural haematomas is a rare entity and has been reported to have a poor outcome. We report 23 patients with traumatic intracerebellar haematoma. We sought to study the pattern of such presentations and assess the factors which could be associated with their outcome.

A retrospective review of prospectively collected data for all patients who were admitted for the management of traumatic intracerebellar haematoma at Rajendra Institute of Medical Sciences, Ranchi, India provided data for the 23 consecutive patients admitted for aforesaid over a seven-year study period. Medical records, diagnostic imaging and operative notes were reviewed for all patients. We divided the patient pool in to two groups based on their GCS score at the time of presentation - Group A (GCS > 7) and Group B (GCS ≤ 7). The association of different allied factors was studied and statistically analyzed. The relevant medical literature was also reviewed.

Most Group B patients were found to be associated with poor outcome at hospital discharge. The overall incidence of poor outcome in our study was 69.56%. GCS score at time of admission, allied supratentorial lesions, advanced age, condition of fourth ventricle and chest infection were found to be important factors which could be associated with poor outcome.

Surgery in patients with the mentioned risk factors remains debatable and should be approached cautiously. Larger multi-institutional and meta-analytic studies are required to study and statistically establish the factors which might be associated with poor outcome in these patients. An algorithm which may be used in the management of traumatic intracerebellar haematoma patients is proposed.