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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Comparative study of the conservative and surgical treatment of spontaneous cerebellar hemorrhage
Chaozhen Yang1,2, Lei Huang1, Ping Xu3
1Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.
Insights
Surgical treatment (ST) for spontaneous cerebellar hemorrhage (SCH) with hematoma volume >10 mL shows better short-term prognosis and lower mortality than conservative treatment (CT). Surgery is an independent predictor of good prognosis in these patients.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Spontaneous cerebellar hemorrhage (SCH) has a high mortality rate.
- Treatment indications for SCH, particularly with large hematomas (>10 mL), remain unclear.
- Available treatments include surgical treatment (ST) and conservative treatment (CT).
Purpose of the Study:
- To compare the outcomes of conservative versus surgical treatment for spontaneous cerebellar hemorrhage (SCH) patients with hematoma volume >10 mL.
- To identify predictors of prognosis in SCH patients.
Main Methods:
- Retrospective study of 98 SCH patients (2014-2024) with hematoma volume >10 mL.
- Patients were stratified into CT (n=41) and ST (n=57) groups using a 1:2 ratio based on hematoma volume and diameter.
- Univariate analysis and multivariate binary logistic regression were used to analyze clinical characteristics, complications, and prognosis.
Main Results:
- The ST group demonstrated a significantly higher proportion of good prognoses at 1 and 3 months (71.9% vs. 46.3%, p=0.010; 59.6% vs. 34.1%, p=0.013).
- The ST group exhibited a lower mortality rate compared to the CT group (17.9% vs. 39.5%, p=0.020).
- Multivariate analysis confirmed ST as an independent predictor of better 1- and 3-month prognosis (OR: 4.898, p=0.007; OR: 3.965, p=0.008).
Conclusions:
- Surgical treatment is associated with improved short-term prognosis and reduced mortality in spontaneous cerebellar hemorrhage patients with hematoma volume >10 mL.
- For SCH patients with bleeding volume exceeding 10 mL, surgery independently predicts a good short-term prognosis.
Background And Purpose:
The mortality rate of spontaneous cerebellar hemorrhage (SCH) is extremely high. Currently, only surgical treatment (ST) and conservative treatment (CT) methods are available; however, the indications for the treatment of SCH are not yet clear. In this study, we compared the outcomes of conservative and surgical treatment methods for patients with SCH and a hematoma volume of >10 mL.
Methods:
We retrospectively included patients with SCH who were treated in the Emergency Department of the Affiliated Hospital of Guizhou Medical University, the Neurosurgery Department of the Affiliated Jinyang Hospital of Guizhou Medical University, and the Neurosurgery Department of the Second Affiliated Hospital of Guizhou Medical University from April 2014 to January 2024. Patients were divided into CT group and ST group using a 1:2 stratified matching method based on hematoma volume and diameter. We collected baseline clinical characteristics of patients, including age, blood pressure, imaging data, complications, and prognosis, and conducted univariate analysis. After excluding factors with collinearity effects through collinearity diagnosis, we used a binary logistic regression model to analyze the independent correlation between good and poor prognosis.
Results:
Based on the inclusion criteria, 98 patients with SCH were screened, comprising 41 patients in the CT group and 57 patients in the ST group. Univariate analysis showed that the ST group had a higher proportion of patients with good prognosis at 1 and 3 months [41(71.9%) vs. 19(46.3%), p = 0.010], [34(59.6%) vs. 14(34.1%), p = 0.013], and a lower mortality rate than the CT group [10(17.9%) vs. 15(39.5%), p = 0.020]. SCH is further divided into a 1-month good prognosis group and a poor prognosis group, and a 3-month good prognosis group and a poor prognosis group. After excluding factors through collinearity diagnosis, the results of multivariate binary logistic regression analysis showed that surgical treatment had better 1- and 3-month prognosis than conservative treatment in SCH patients (OR: 4.898, 95% CI: 1.559-15.388, p = 0.007, OR: 3.965, 95% CI: 1.429-11.004, p = 0.008).
Conclusion:
When the bleeding volume of SCH patients is greater than 10 mL, surgery is an independent predictor of good short-term prognosis.
