gms | German Medical Science

Objective: The increasing number of elderly patients in the European population changes criterias of indication in surgery. Due to longer life expectancy decompressive surgery for stroke and intracerebral hemorrhage appears to become discussable even in geriatric patients. A special group are old patients with spontaneous cerebellar hemorrhage. The investigation assesses the outcome of surgically treated patients who presented with spontaneous deterioration with respect to premorbidity and usefulness of rehabilitation.

Methods: We present a retrospective analysis of a series of 24 patients, over the age of 65 years, with spontaneous cerebellar hemorrhage. All patients were in good condition before the onset of acute deterioration, nevertheless the premorbidity was evaluated. Clinical signs of imminent herniation or radiological markers were considered. The treatment was decompressive craniectomy with evacuation of the hematoma in all patients and temporary or permanent ventricular drainage. Almost all patients were sent to a rehabilitation unit. A long-term follow-up was performed, outcome was defined using Glasgow coma score (GOS), Karnovsky- and Barthel-Index.

Results: One patient died within acute hospitalisation. 3 years after the surgical treatment, 66% of the patients were still alive. Secundary complications due to the posthemorrhagic immobilisation were cause of death in the remaining third of patients. 59% of the patients remained severely disabled (Karnovsky <40). 26% got rehabilitation to an individually reasonable life quality (Karnovsky >40). 20% (over 75-year-old) regained indepence and good life quality (Karnovsky 70 or more). Median time of acute hospitalisation was 21 days. 54% presented preoperatively with a GOS>10. Concerning premorbidity, 75% were treated due to hypertension and received anticoagulants. 33% of the patients – all with good or reasonable outcome postoperatively – presented with benefit of the postoperative rehabilitation, only the patients with immediate postoperative improvement profit from this adjuvant therapy.

Conclusions: The age of the patients and their estimated premorbidity were not significantly associated with fatal outcome. Intensive treatment for cerebellar hematomas, including suboccipital craniotomy, may be justified even in geriatric patients, who are in reasonable condition preoperatively. Only the patients with good operative result profit from rehabilitation therapy.