Abstract：
BACKGROUND: Cerebellar intracerebral hemorrhage (ICH) is associated with poor functional prognosis and high mortality. Surgical evacuation has been proposed to improve outcome. The purpose of this review was to determine the benefit of surgical evacuation of cerebellar ICH and to establish guidelines for when it should be performed.
METHODS: The writing committee comprised 9 members of the SFNV and the SFNC. Recommendations were established based on a literature review using the PICO questions. The American Heart Association (AHA) classification was used to define recommendation level. In case of insufficient evidence, expert opinions were provided.
RESULTS: Levels of evidence were low to moderate, precluding definitive recommendations. Based on available data, surgical hematoma evacuation is not recommended to improve functional outcome (Class III; Level B NR). However, based on subgroup analysis, surgical evacuation may be considered in strictly selected patients (Class IIb; Level C-EO): hematoma volume 15-25 cm3, GCS 6-10, and no oral anticoagulation or antiplatelet therapy. Moreover, surgical evacuation is recommended to decrease risk of death (Class IIa; Level B NR) in patients with a hematoma volume >15 cm3 and GCS score <10.
CONCLUSIONS: These guidelines were based on observational studies, limiting the level of evidence. However, except for strictly selected patients, surgical evacuation of cerebellar ICH was not associated with improved functional outcome, limiting indications. Data from RCTs are needed in this field.
METHODS: The writing committee comprised 9 members of the SFNV and the SFNC. Recommendations were established based on a literature review using the PICO questions. The American Heart Association (AHA) classification was used to define recommendation level. In case of insufficient evidence, expert opinions were provided.
RESULTS: Levels of evidence were low to moderate, precluding definitive recommendations. Based on available data, surgical hematoma evacuation is not recommended to improve functional outcome (Class III; Level B NR). However, based on subgroup analysis, surgical evacuation may be considered in strictly selected patients (Class IIb; Level C-EO): hematoma volume 15-25 cm3, GCS 6-10, and no oral anticoagulation or antiplatelet therapy. Moreover, surgical evacuation is recommended to decrease risk of death (Class IIa; Level B NR) in patients with a hematoma volume >15 cm3 and GCS score <10.
CONCLUSIONS: These guidelines were based on observational studies, limiting the level of evidence. However, except for strictly selected patients, surgical evacuation of cerebellar ICH was not associated with improved functional outcome, limiting indications. Data from RCTs are needed in this field.
摘要：
背景：小脑内出血（ICH）与不良的功能预后和高死亡率相关。已提出手术疏散以改善结果。这项审查的目的是确定小脑ICH手术后的益处，并建立何时应进行的指南。
方法：写作委员会由SFNV和SFNC的9名成员组成。建议是根据使用PICO问题的文献综述建立的。美国心脏协会（AHA）分类用于定义推荐水平。在证据不足的情况下，提供了专家意见。
结果：证据水平低至中等，排除明确的建议。根据现有数据，不建议手术血肿清除术改善功能结局(III类;B级NR).然而,基于子群分析，对于严格选择的患者(IIb级;C-EO级),可考虑进行手术疏散:血肿体积15~25cm3,GCS6~10,且无口服抗凝治疗或抗血小板治疗.此外，对于血肿体积>15cm3且GCS评分<10的患者,建议进行手术疏散以降低死亡风险(IIa级;B级NR).
结论：这些指南基于观察性研究，限制证据水平。然而,除了严格挑选的病人，手术清除小脑ICH与改善的功能结局无关,限制性适应症。在该字段中需要来自RCT的数据。
方法：写作委员会由SFNV和SFNC的9名成员组成。建议是根据使用PICO问题的文献综述建立的。美国心脏协会（AHA）分类用于定义推荐水平。在证据不足的情况下，提供了专家意见。
结果：证据水平低至中等，排除明确的建议。根据现有数据，不建议手术血肿清除术改善功能结局(III类;B级NR).然而,基于子群分析，对于严格选择的患者(IIb级;C-EO级),可考虑进行手术疏散:血肿体积15~25cm3,GCS6~10,且无口服抗凝治疗或抗血小板治疗.此外，对于血肿体积>15cm3且GCS评分<10的患者,建议进行手术疏散以降低死亡风险(IIa级;B级NR).
结论：这些指南基于观察性研究，限制证据水平。然而,除了严格挑选的病人，手术清除小脑ICH与改善的功能结局无关,限制性适应症。在该字段中需要来自RCT的数据。
