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Journal of Neurosurgical Sciences 2001 March;45(1):29-37

language: English

Traumatic intra­cer­e­bel­lar hemor­rhag­ic con­tu­sions and hemat­o­mas

D'Avella D., Cacciola F., Angileri F. F., Cardali S., La Rosa G., Germanò A., Tomasello F.

Department of Neurosurgery, University of Messina School of Medicine, Messina, Italy


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Background. Traumatic intra­cer­e­bel­lar hemor­rhag­ic con­tu­sions and hemat­o­mas (­TIHC) are unusu­al ­lesions and ­their sur­gi­cal man­age­ment ­remains con­tro­ver­sial.
Methods. From January 1990 to July, 1998, 3290 ­patients under­went com­put­ed tomog­ra­phy for ­acute ­head trau­ma at our Institution. Eighteen ­patients (0.54%) ­were ret­ro­spec­tive­ly iden­ti­fied as har­bor­ing ­TIHC. Patients ­were divid­ed ­into two ­groups. In Group I (n=78) GCS at admis­sion was ≥9. Seven ­patients pre­sent­ed ­with “iso­lat­ed” ­TIHC and one ­with an asso­ciat­ed supra­ten­to­ri­al ­lesion. Three ­patients exhib­it­ed an evolv­ing clin­i­co-radio­log­i­cal ­course. In Group II ­patients (n=10) GCS at admis­sion was ≤7. All but one pre­sent­ed ­with ­severe supra­ten­to­ri­al ­lesions and asso­ciat­ed brain­stem ­signs.
Results. In ­group I six ­patients had ­their ­TIHC man­aged con­ser­va­tive­ly, and two ­were oper­at­ed on, and all recov­ered com­plete­ly. In ­group II, two ­patients ­were oper­at­ed on. The out­come was ­poor in 90% of cas­es.
Conclusions. ­TIHC con­sti­tute a pro­te­an clin­i­co-path­o­log­i­cal ­entity. Non-coma­tose ­patients ­with intra­cer­e­bel­lar ­clots ­less ­than 3 cm in diam­e­ter ­should be treat­ed con­ser­va­tive­ly and expect­ed to ­make a ­good recov­ery. Surgery is indi­cat­ed for larg­er hemat­o­mas caus­ing cis­ter­nal and IV ven­tri­cle com­pres­sion ab ­initio or as a ­result of ­their sec­on­dary evo­lu­tion. In severe­ly ill ­patients admit­ted coma­tose, it is gen­er­al­ly the pri­mary ­brain ­stem dam­age and the con­com­i­tant ­severe supra­ten­to­ri­al ­lesions to dic­tate the prog­no­sis. In ­these cas­es oblit­er­a­tion of the pos­te­ri­or fos­sa cis­terns is the ­most reli­able indi­ca­tor of ­poor out­come.

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