Introduction: Intracerebral hemorrhage (ICH) causes 10% to 15% of first-ever stroke, with a 30-day mortality rate of 35% to 52%. Death at 1 year varies by location of ICH: 51% for deep hemorrhage, 57% for lobar, and 42% for cerebellar. Only 21% to 38% of patients with ICH were independent at 6 months. The purpose of this study was to describe prognostic factors for postoperative outcome in patients with acute cerebellar hemorrhage.

Methods: Over a period of 5 years (2007-2011), 48 adult patients, retrospectively identified as having acute cerebellar hemorrhage using preexisting standardized evaluation forms at Kaohsiung Chang Gung Memorial Hospital underwent neurological surgery. Baseline demographic and clinical data were recorded. Outcome was assessed 2 years following neurological surgery using the 5-point Glasgow outcome scale (GOS). Good outcome was defined as GOS 5 and 4; poor outcome was GOS 3, 2, and 1.

Results: There were 48 patients with acute cerebellar hemorrhage greater than 3 cm in diameter undergoing neurological surgery which included suboccipital craniectomy and/or external ventricular drainage (EVD). Mean age was 63 years old. 9 patients underwent suboccipital craniectomy only; 38 for both suboccipital craniectomy and EVD. Overall mortality rate was 35.4%. 14 patients (29.2%) had good outcome. Poor outcome on the GOS 2 years after surgical treatment of acute cerebellar hemorrhage was identified as association with NIHSS scores at discharge.

Conclusions: In summary, our study demonstrated that an addition of one NIHSS point at discharge will increase the probability of 2-year postoperative poor outcome by 27.6% in patients with acute spontaneous cerebellar hemorrhage undergoing neurological surgery.

Patient Care: My research might help determine the 2-year postoperative prognostic factors of acute cerebellar hemorrhage in patients undergoing neurological surgery.

Learning Objectives: By the conclusion of this session, participants could be able to identify that higher NIHSS scores at discharge are associated with an increased postoperative severity of acute cerebellar hemorrhage.

References: 1. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P, Zuccarello M: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38:2001-2023, 2007 2. Olavarría VV, Delgado I, Hoppe A, Brunser A, Cárcamo D, Díaz-Tapia V, Lavados PM: Validity of the NIHSS in predicting arterial occlusion in cerebral infarction is time-dependent. Neurology 76:62-68, 2011 3. Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A: Treatment of hypertensive cerebellar hemorrhage--surgical or conservative management? Neurosurgery 34:246-250, 1994