Traumatic isolated intracerebellar haematoma without any supratentorial lesion

Purpose. Pure isolated cerebellar haematoma of traumatic aetiology, without associated posterior fossa sub- or epidural haematomas and without supratentorial bleed is a rare entity. We conducted this retrospective study to analyze the management strategy of isolated traumatic intracerebellar haematoma without supratentorial lesion in our institute. Methods. We retrospectively reviewed records of more than 15000 head injury patients in our department of neurosurgery between January 2014 and November 2019. In this isolated intracerebellar hematoma patients are 60. Patients were divided into two groups assessed by the GCS score at the time of presentation – Group A (GCS>13) Group B (GCS lesser than or equal to 13). Group A treated conservatively and B surgically. Group A subdivided according to the size of hematoma into1st (>3cm ) and 2nd (<3 cm ). Group B subdivided according to GCS into 1st ( <8 ) and 2nd ( 8-13). Results. Most Group B, subgroup 1st ( GCS<8) patients found to be associated with poorer outcome ( 60 %) and subgroup 2nd ( GCS 8-13) had only 10 %. Group A subgroup 1st ( > 3 cm hematoma) has associated with poor outcome ( 28.57%) and Subgroup 2nd ( < 3 cm ) has 4.34% . GCS score at the time of admission, hematoma size, hematoma location, the timing of surgery were important factors for outcome. Conclusion. We concluded that hematoma size is > 3 cm and GCS > 8 patient should operate within 12 hr. Patient of GCS < 8 results of surgery are poor( 60%.) .If the size of hematoma < 3 cm, lateral hematoma and GCS >13 should be treated conservatively. The factors which may be associated with the poor outcome are Low GCS score at the time of admission(<8), the large size of hematoma (>3cm), median location and delay time of surgery(>12hr).

A Case of Posterior Fossa Dural Arteriovenous Fistulas Successfully Treated with Transarterial Embolization

A 40-year-old man was transferred to our hospital due to sudden headache while swimming in the pool. CT revealed cerebellar haematoma within vermis associated with subarachnoid haemorrhage (SAH). Digital subtraction angiography (DSA) showed dural arteriovenous fistulas (DAVFs) with venous pouch on the surface of cerebellar vermis. Fistulas were on the meningeal surface near the sinus confluence. Draining veins formed venous pouch invaginating into cerebellar vermis. Transarterial embolization (TAE) was performed under the concept that main feeder should be embolized last to occlude the DAVFs completely. Post-embolization 3D-CT showed the cast of N-butyl –cyanoacrylate (NBCA) in the fistulas as well as in the drainer. The good order of occlusion made the embolization complete.