Christopher P Kellner1, Frank Moore2, Marc S Arginteanu2, Alfred A Steinberger2, Kevin Yao2, Jacopo Scaggiante3, J Mocco3, Yakov Gologorsky2. 1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: christopher.kellner@mountsinai.org. 2. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurosurgery, Englewood Hospital and Medical Center, Englewood, New Jersey, USA. 3. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
OBJECTIVE: Spontaneous cerebellar intracerebral hemorrhage (scICH) constitutes ∼10% of all cases of spontaneous ICH, with a mortality of 20%-50%. Suboccipital craniectomy (SOC) is commonly performed for scICH causing brainstem compression or hydrocephalus. However, SOC requires long anesthesia times and results in a high complication rate. We present a series of patients who minimally invasive scICH evacuation as an alternative to traditional SOC. METHODS: We retrospectively reviewed the operative records for patients presenting to a single center from January 1, 2009 to March 1, 2017. All patients who had undergone evacuation of scICH were included in the present study. Clinical and radiographic variables were collected, including admission and postoperative Glasgow coma scale (GCS) scores, preoperative and postoperative hematoma volumes, and modified Rankin scale (mRS) scores at long-term follow-up. RESULTS: We identified 10 patients who had presented with scICH requiring surgery. All scICH evacuations were performed through a minicraniectomy positioned in the suboccipital area as close to the hematoma as possible. The mean patient age was 64.1 years. The mean presenting GCS score was 8.6, the mean initial hematoma volume was 25.4 mL, the mean procedure time was 57 minutes, and the mean postoperative hematoma volume was 2.8 mL. The mortality rate was 10% and mean long-term follow-up mRS score was 2. CONCLUSIONS: Minimally invasive scICH hematoma evacuation is a feasible alternative to SOC with numerous advantages that could lead to improved radiographic and clinical results.
OBJECTIVE:Spontaneous cerebellar intracerebral hemorrhage (scICH) constitutes ∼10% of all cases of spontaneous ICH, with a mortality of 20%-50%. Suboccipital craniectomy (SOC) is commonly performed for scICH causing brainstem compression or hydrocephalus. However, SOC requires long anesthesia times and results in a high complication rate. We present a series of patients who minimally invasive scICH evacuation as an alternative to traditional SOC. METHODS: We retrospectively reviewed the operative records for patients presenting to a single center from January 1, 2009 to March 1, 2017. All patients who had undergone evacuation of scICH were included in the present study. Clinical and radiographic variables were collected, including admission and postoperative Glasgow coma scale (GCS) scores, preoperative and postoperative hematoma volumes, and modified Rankin scale (mRS) scores at long-term follow-up. RESULTS: We identified 10 patients who had presented with scICH requiring surgery. All scICH evacuations were performed through a minicraniectomy positioned in the suboccipital area as close to the hematoma as possible. The mean patient age was 64.1 years. The mean presenting GCS score was 8.6, the mean initial hematoma volume was 25.4 mL, the mean procedure time was 57 minutes, and the mean postoperative hematoma volume was 2.8 mL. The mortality rate was 10% and mean long-term follow-up mRS score was 2. CONCLUSIONS: Minimally invasive scICH hematoma evacuation is a feasible alternative to SOC with numerous advantages that could lead to improved radiographic and clinical results.
Authors: Kainaat Javed; Mousa K Hamad; Ryan Holland; Adisson N Fortunel; Adam Ammar; Phillip C Cezayirli; Neil Haranhalli; David J Altschul Journal: Cureus Date: 2021-07-02