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Aktuelle Neurologie 2004; 31(4): 180-187
DOI: 10.1055/s-2003-814931
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Spontane Kleinhirnblutung

Wann ist eine chirurgische Therapie indiziert?Spontaneous Cerebellar HemorrhageIndications for Surgical TreatmentS.  Schwarz1 , M.  Daffertshofer1 , S.  Dolderer2 , D.  Georgiadis3 , A.  Aschoff4
  • 1Neurologische Universitätsklinik, Klinikum Mannheim der Universität Heidelberg
  • 2Neurologische Klinik, Universität Heidelberg
  • 3Neurologische Klinik, Universitätsspital Zürich, Schweiz
  • 4Neurochirurgische Klinik, Universität Heidelberg
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Publication History

Publication Date:
07 May 2004 (online)

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Zusammenfassung

Konservative Therapieverfahren wurden bisher bei der Kleinhirnblutung nicht untersucht. Vielfach wird eine operative Hämatomausräumung bei Patienten mit großen Hämatomen, Hydrozephalus oder Bewusstseinstrübung empfohlen. Die Detailindikation zur Operation wird allerdings sehr unterschiedlich gesehen. Kontrollierte Studien zur Hämatomausräumung bei Kleinhirnblutungen liegen nicht vor. Auch über das optimale chirurgische Verfahren besteht keine Einigkeit. Es werden verschiedene chirurgische Methoden der Hämatomausräumung mit oder ohne Anlage einer Ventrikeldrainage angewendet, ohne dass wissenschaftliche Daten für das jeweilige Verfahren sprechen. Die Langzeitprognose der Kleinhirnblutung ist unklar. Die bisherigen Studien zeigen sowohl unter konservativer und operativer Behandlung eine hohe Mortalität. Die operative Hämatomausräumung bei bestimmten Patienten hat sich heute weitgehend durchgesetzt. Aufgrund der dürftigen Datenlage ist der Nutzen dieser Behandlung aber nicht sicher geklärt.

Abstract

Up to now, specific medical treatment strategies for cerebellar hemorrhage are not established. Usually, surgical hematoma evacuation is recommended in patients with a large hematoma, hydrocephalus or loss of consciousness. However, the indications for surgical interventions are still controversial. Prospective studies on hematoma evacuation in patients with a cerebellar hemorrhage are not available. Furthermore, the optimum surgical treatment strategy remains debatable. The choice of surgical procedure remains highly controversial. Different surgical methods of hematoma evacuation with or without external ventricular drainage are employed. The long-term prognosis after cerebellar hemorrhage has not yet been satisfactorily evaluated. The mortality after surgical or medical treatment is still high. Therefore, although the surgical treatment is firmly established in the current clinical practice, the possible benefits of surgical hematoma evacuations are not proven, and new prospective studies are urgently warranted.

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PD Dr. Stefan Schwarz

Neurologische Universitätsklinik · Klinikum Mannheim der Universität Heidelberg

Theodor-Kutzer-Ufer 1 - 3

68135 Mannheim

Email: s.schwarz@neuro.ma.uni-heidelberg.de