Spontaneous bleeding into the brain remains a frustrating and challenging disease. Surgical hematoma evacuation seems intuitive, but clinical trials of evacuation of supratentorial hemorrhages, to date, have been unable to identify a procedure or a specific subset of patients for whom surgery is clearly indicated. However, hemorrhage into the cerebellum has long been viewed as distinctively responsive to intervention, considered by many as a surgical lesion, based on small case series and broad anecdotal experience. However, this perspective has never been assessed in a randomized study as large surgical trials have not included patients with cerebellar intracerebral hemorrhage (ICH).1,2 Nontraumatic cerebellar hemorrhage affects approximately 10 000 patients in the United states each year and accounts for approximately 10% of all ICHs and 1.5% of all strokes.3 Guidelines for management of cerebellar ICH vary from recommending hematoma evacuation for patients with deteriorating conditions, while acknowledging this is based on expert consensus,4 to avoiding making recommendations due to insufficient evidence.5
Hemphill JC, Amin-Hanjani S. Cerebellar Intracerebral Hemorrhage: Time for Evidence-Based Treatment. JAMA. 2019;322(14):1355–1356. doi:10.1001/jama.2019.14673
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