Indications for surgical treatment of cerebellar haemorrhage and infarction.

This report summarizes the outcome of 56 patients with cerebellar lesions of vascular origin, 40 patients with cerebellar infarction, and 16 with spontaneous cerebellar haemorrhage. All patients had computerized tomography: occlusive hydrocephalus was diagnosed in 75% of patients with cerebellar haemorrhage and in 23% with cerebellar infarction. Nine out of 10 patients survived after early surgical evacuation of the haematoma and 4 of them recovered completely. Two patients underwent only external ventricular drainage (EVD), one died after 2 days, and the other recovered with a moderate deficit. Three of 4 medically treated patients died within one week; all had developed occlusive hydrocephalus. The fourth medically treated patient recovered completely; consciousness had never deteriorated nor had occlusive hydrocephalus developed. Among 40 patients with cerebellar infarction, 13 developed progressive deterioration of consciousness; 7 of them underwent decompressive craniectomy of the posterior fossa and survived. One patient had only external ventricular drainage and died. Four out of the 5 medically treated patients died during the acute phase. From these observations and several reports in the literature, it is concluded that both cerebellar haemorrhage and infarction should be operated on as soon as progressive deterioration of consciousness develops. This occurs more frequently in patients with cerebellar haemorrhage than with cerebellar infarction. Individual decision-making in each case necessitates intensive neurosurgical observation.