Safety and Outcome of Suboccipital Mini-Craniectomy for the Evacuation of Spontaneous Cerebellar Hemorrhage

Objective: Spontaneous cerebellar hemorrhage (SCH) that may cause severe brain stem compression, obstructive hydrocephalus, and cerebellar herniation is life threatening condition. Large suboccipital craniectomy has been traditionally used to evacuate SCH, which has long operative time and local tissue damage, and associated with high morbidity and mortality. We examined the effectiveness and outcome of our experience in the management of SCH with suboccipital minimal invasive “Mini-Craniectomy” (MC). Methods: This retrospective study was performed between July 2002 and August 2013 in two tertiary hospitals in the western region of Saudi Arabia for all patients were admitted with SCH. The patients were treated conservatively if they presented with Glasgow Coma Scale (GCS) of 13 or more and their computed tomography (CT) scans on admission revealed ahematoma sizeless than30 mm in maximal diameter and no evidence of brain stem compression or hydrocephalus. While, Surgical intervention with MC was considered for patients with GCS less than 13 and with CT findings of hematoma size more than 30 mm in maximal diameter, and/or brain stem compression or hydrocephalus. Glasgow outcome score (GOS) was identified for all patients at their 3-moth follow up. Results: Thirty-eight patients with SCH were included in this study with mean age of 63.5 years. Twenty-six patients (68%) were males and 12 (32%) were females. Three patients presented with GCS of 3 were offered palliative support. Non-operative management was indicated for 13 patients, and 22 patients underwent emergency MC and evacuation of cerebellar hematoma (CH). In the non-operative group, 2 patients deteriorated neurologically and underwent MC, and another patient required insertion of ventriculoperitoneal shunt (VPS) for progressive hydrocephalus. In the operative group (n= 24),2 had a local rebleed and required were reoperation, 2developed worsening of hydrocephalus and required external ventricular drains (EVD), one of them eventually requiredVPS. Suboccipital pseudomeningocele, occurred in 3 patients and resolved after 5 days of external lumbar drainage. At 3-month follow up, all patients treated conservatively (n=11) had favorable GOS.Patient who underwent MC (n=24), 19 patients (79%) had favorable GOS (3 had mild disability and 16 returned back to their baseline neurological status). Five patients (21%) had unfavorable GOS (3 patients died, 2 patients had severe disability and were dependent). Conclusion: The results of this study indicate that surgery for SCH through a MC is effective surgical procedure with good outcome. [Saleh S. Baeesa and Montasser A. Foda. Safety and Outcome of Suboccipital Mini-Craniectomy for the Evacuation of Spontaneous Cerebellar Hemorrhage. Life Sci J 2014; 11(10): 432-438] (ISSN: 1097-8135). http://www.lifesciencesite.com. 59