[CT-guided stereotaxic evacuation of cerebellar hematoma--lateral approach]

Stereotaxic lateral approach for cerebellar hematoma is presented using Leksell's CT-stereotaxic system. All of the procedures are performed in the CT room. Patient's head is turned to contralateral side of the hematoma 30 to 40 degrees with slight flexion of the neck. Stereotaxic apparatus is secured to the head under local anesthesia. Hematoma is confirmed by computerized tomograms. Three dimensional coordinates of the target point (center of the hematoma) are measured from the vertical and diagonal rods of Leksell's system. Linear skin incision 4 cm in length is made on retromastoid area. Burr-hole is put on just lateral position of the target point, usually 5 to 6 cm posterior and 1 cm above from the external auditory meatus. Transverse or sigmoid sinus does not appeared through the burr-hole by this approach. Specially made Dandy's cannula (3.0 mm in diameter, 220 mm in length) is inserted into the target point, and manual evacuation of the hematoma is performed carefully using a syringe. Then Dandy's cannula is replaced by silastic drainage tube (3.5 mm in diameter), and 6,000 Units of Urokinase solved in 2 ml of saline is administered to the hematoma cavity. Dissolved hematoma is aspirated every 24 hours until the most of the hematoma is evacuated. We operated three cases of cerebellar hematoma by this method with favorable results. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the residual hematoma and position of the tip of cannula even at operation, if necessary.