Treatment of cerebellar masses

Mahmut Edip Gurol, Erik K St Louis

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Cerebellar masses are a heterogenous group of conditions that can cause compression of the aqueduct or fourth ventricle, resulting in obstructive hydrocephalus, brainstem compression, and upward/downward herniation as a direct result of mass effect. Untreated lesions can be fatal in a few hours, but prompt and appropriate treatment of the mass effect can produce very good outcomes. These patients should be closely followed in a critical care setting that has rapid access to neurosurgical expertise. Medical measures to decrease brain edema should be taken, including elevation of the head of the bed and avoidance of hypo-osmolar solutions, hypercarbia, or hyperthermia. Osmotic diuretics should be initiated promptly in patients with clinical worsening and radiographic evidence of edema resulting in mass effect. However, medical measures should not delay surgical intervention, which should proceed as rapidly as possible when indicated. Cerebellar hemorrhages more than 3 cm in diameter and cerebellar hemispheric strokes involving more than one third of the hemisphere should be considered for early suboccipital craniotomy with decompression. Regardless of lesion size, neurologic deterioration and radiologic signs of obstructive hydrocephalus should call for emergency decompressive surgery with resection of hematoma or necrotic brain tissue. Ventriculostomy should he considered as a bridge to surgical decompression, given the theoretical concern of upward herniation mediated by supratentorial drainage in the face of an underlying posterior fossa mass lesion. Steroids are not indicated for cerebrovascular disease but should be used to treat vasogenic edema induced by tumor. Anticoagulation is reserved for cerebellar venous and dural sinus thrombosis. Specific treatments targeting the underlying pathology should be used aggressively: thrombolysis and endovascular interventions for eligible stroke patients, antibiotic therapy for abscesses, and radiotherapy, chemotherapy, or both for tumors.

Original languageEnglish (US)
Pages (from-to)138-150
Number of pages13
JournalCurrent Treatment Options in Neurology
Volume10
Issue number2
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Hydrocephalus
Edema
Osmotic Diuretics
Stroke
Ventriculostomy
Intracranial Sinus Thrombosis
Fourth Ventricle
Cerebrovascular Disorders
Surgical Decompression
Hypercapnia
Craniotomy
Brain Edema
Critical Care
Decompression
Hematoma
Abscess
Nervous System
Brain Stem
Drainage
Neoplasms

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Treatment of cerebellar masses. / Gurol, Mahmut Edip; St Louis, Erik K.

In: Current Treatment Options in Neurology, Vol. 10, No. 2, 03.2008, p. 138-150.

Research output: Contribution to journalArticle

Gurol, Mahmut Edip ; St Louis, Erik K. / Treatment of cerebellar masses. In: Current Treatment Options in Neurology. 2008 ; Vol. 10, No. 2. pp. 138-150.
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