Introduction: Spontaneous cerebellar intracerebral hemorrhage (scICH) makes up 5 to 13% of all cases of spontaneous ICH and carries a mortality of 20 to 50%. Currently, the only American Heart Association surgical recommendation for spontaneous ICH is in the case of patients with scICH who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction. Here we present a 10 patient series of minimally invasive scICH evacuation as an alternative to the traditional suboccipital craniectomy.
Methods: Operative records were retrospectively reviewed for patients presenting to Englewood Hospital and Medical Center in New Jersey from 1/1/09 to 3/1/17. All patients who underwent surgery for decompression and/or evacuation of scICH were included in this study. Clinical and radiographic variables were collected including admission Glasgow Coma Scale (GCS), preoperative hematoma volume, postoperative hematoma volume, post-operative GCS, and 90 day GCS as well as others.
Results: 10 patients were identified presenting with scICH requiring surgery. All scICH evacuations were performed minimally invasively consisting of a burr hole positioned in the suboccipital area as close to the hematoma as possible. Mean age was 63.7 [47-82], mean presenting GCS was 8.5 [4-15], mean presenting hematoma volume was 49cc [29.8-93.8] , mean procedure time was 57 minutes [37-77], mean post-operative hematoma volume was 1.3cc [0-7.4cc], and mean 90 day GCS was 14 with one mortality shortly after surgery.
Conclusions: Minimally invasive scICH hematoma evacuation is a possible alternative to suboccipital craniectomy that may be capable of achieving good radiographic and clinical results.
Patient Care: Further understanding of infratentorial ICH evacuation will add to the procedures available to treat the disease.
Learning Objectives: By the conclusion of this session, participants should be able to understand the applications of infratentorial ICH evacuation.