四叠体池改变对自发性小脑血肿预后估计

Quadrigeminal Cistern Obliteration on CT Scans as a Prognostication of Spontaneous cerebellar Hematoma

探索四叠体池改变对自发性小脑血肿的预后估计。方法观察和治疗７５例经ＣＴ确诊的自发性小脑血肿病人。血肿最大经＜２ｃｍ１６例，２ｃｍ～４ｃｍ３５例，＞４ｃｍ２４例；四叠体池形态改变分为闭塞１５例、受压３１例和正常２９例。枕下开颅血肿清除３２例，立体定向血肿抽吸术３例，单纯脑室外引流术５例，枕下开颅血肿清除加脑室外引流术３例；保守治疗３２例。结果存活５６例，死亡１９例。四叠体池闭塞者１５例，死亡１４例，植物生存１例；四叠体池受压者３１例，死亡４例，存活２７例；四叠体池正常者２８例，存活２７例，死亡１例。

Objective\ To study the quadrigeminal cistern obliteration on CT scans as a prognostic index for spontaneous cerebellar hematomas.\ Methods\ A series of 75 patients with spontaneous cerebellar hematoma diagnosed by CT scanning was treated. Sixteen patients had hematoma of less than 20 mm in diameter on CT scan,35 patients with 20￣40 mm,and 24 patients with >40 mm hematoma in size. Obliteration of the quadrigeminal cisterns was classified on CT scans into three grade: normal ( n =29), compressed ( n =31), or absent ( n =15). Evacuation of hematoma by suboccipital craniotomy were performed in 32 patients and CT guided stereotactic aspiration were performed in 3 cases, Seven cases were underwent ventricular drainage alone for hydrocephalus. Both suboccipital craniotomy and ventricular drainage were performed in 9 cases.\ Results\ Nineteen patients (25.3%) died and fifty six patients was survived. Among the 75 patients, 14 of 15 patients with an absent cistern died and only one survived with vegetative state, 4 of 31 patients with an compressed cistern died, only one of 29 patients with normal cistern died.\ Conclusion\ The quadrigeminal cistern obliteration on CT scans is an accurate indicator of outcome and is useful in selecting appropriate treatment for patients with cerebellar hematomas.