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

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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