• Sanjula D Singh, SchreuderFloris H B MFHBMDepartment of Neurology, Donders Institute for Brain Cognition and Behavior, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands., Koen M van Nieuwenhuizen, Wilmar M Jolink, Jasper R Senff, Joshua N Goldstein, Jeroen Boogaarts, KlijnCatharina J MCJMDepartment of Neurology, Donders Institute for Brain Cognition and Behavior, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands., RinkelGabriel J EGJEDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands., and H Bart Brouwers.
• Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. Sanjula.Singh@DPH.ox.ac.uk.
• Neurocrit Care. 2021 Dec 1; 35 (3): 680-686.

BackgroundIn patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation.MethodsWe included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome.ResultsOf 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0-3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0-3).ConclusionsWhile cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.© 2021. The Author(s).

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