Immediate Surgery Reduces Mortality in Deeply Comatose Patients with Spontaneous Cerebellar Hemorrhage

概要

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Cerebellar hemorrhage is regarded as a neurosurgical emergency. However, patients with deterio-rating consciousness are very likely to die irrespective of the choice of therapy, and it is not clear if surgical intervention can benefit patients in a deeply comatose state. We reviewed 20 patients with a Glasgow Coma Scale score of 3 at admission to ascertain the salvage rate and determine the prognostic factors. Four patients who were managed conservatively died within 2 days. Sixteen pa-tients underwent decompressive suboccipital craniectomy and hematoma evacuation. At discharge, three patients were moderetely disabled, three were severely disabled, four were persistently vageta-tive, and six had died. The overall mortality was 50%. The mean interval between the onset of symp-toms and the operation was 1.67 ± 0.29 hours in patients with favorable outcome, and significantly longer at 2.42 ±0.49 hours in patients with an unfavorable outcome(p=0.025). Immediate evacua-tion of the hematoma reduces morbidity and mortality even in deeply comatose patients, especially if the time interval between the onset and surgery is within 2 hours.
日本脳神経外科学会の論文
2000-06-15