J Korean Neurosurg Soc.  2012 Oct;52(4):320-324. 10.3340/jkns.2012.52.4.320.

Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage : Risk Factors Associated with Ventriculoperitoneal Shunt

• Shin D
• Woo HJ
• Park J

• KMID: 2190647
• DOI: http://doi.org/10.3340/jkns.2012.52.4.320

Abstract

OBJECTIVE
The purposes of this study are to investigate the factors that may be related to ventriculoperitoneal (VP) shunt in patients with cerebellar hematoma and the effect of severe fourth ventricular hemorrhage, causing obstructive hydrocephalus on subsequent VP shunt performance.
METHODS
This study included 31 patients with spontaneous cerebellar hematoma and concomitant fourth ventricular hemorrhage, who did not undergo a surgical evacuation of hematoma. We divided this population into two groups; the VP shunt group, and the non-VP shunt group. The demographic data, radiologic findings, and clinical factors were compared in each group. The location of the hematoma (whether occupying the cerebellar hemisphere or the vermis) and the degree of the fourth ventricular obstruction were graded respectively. The intraventricular hemorrhage (IVH) score was used to assess the IVH severity.
RESULTS
Ten out of 31 patients underwent VP shunt operations. The midline location of cerebellar hematoma, the grade of fourth ventricle obstruction, and IVH severity were significantly correlated with that of VP shunt operation (p=0.015, p=0.013, p=0.028). The significant variables into a logistic regression multivariate model resulted in statistical significance for the location of cerebellar hemorrhage [p=0.05; odds ratio (OR), 8.18; 95% confidence interval (CI), 1.00 to 67.0], the grade of fourth ventricle obstruction (p=0.044; OR, 19.26; 95% CI, 1.07 to 346.6).
CONCLUSION
The location of the cerebellar hematoma on CT scans and the degree of fourth ventricle obstruction by IVH were useful signs for the selection of VP shunt operation in patients with spontaneous cerebellar hematoma and concomitant acute hydrocephalus.

Keyword

Cerebellar hematoma; Intraventricular hemorrhage; Hydrocephalus; Fourth ventricular obstruction

MeSH Terms

Fourth Ventricle
Hematoma
Hemorrhage
Humans
Hydrocephalus
Logistic Models
Odds Ratio
Risk Factors
Ventriculoperitoneal Shunt

Figure

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  Fig. 1 CT scans demonstrating different cerebellar hematomas and the degree of the fourth ventricle obstruction on the axial CT slice. A : hematoma in one cerebellar hemisphere and partial obstruction of fourth ventricle (Grade I). B : hematoma occupying midline or vermis and partial obstruction of fourth ventricle (Grade I). C : hematoma involving both cerebellar hemisphere and vermis and complete obstruction of fourth ventricle (Grade II).

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