Suboccipital Lateral Approach in the Supine Position for Stereotactic Aspiration of Cerebellar Hematoma.

Kim, Joon Oh; Lee, Myung Ki; Park, Il Han; Kim, Joong Seok; Kim, Dae Jo

Original Article

Journal of Korean Neurosurgical Society 2004;35(2): 183-187.

Joon Oh Kim, Myung Ki Lee, Il Han Park, Joong Seok Kim, Dae Jo Kim

Department of Neurosurgery, Maryknoll General Hospital, Busan, Korea. stereomk@shinbiro.com

ABSTRACT

OBJECTIVE
We report a suboccipital lateral approach in order to propose more suitable stereotactic aspiration technique for cerebellar hematoma. METHODS: Using the Leksell's CT-stereotactic system, the patient was kept on a supine position under local anesthesia turning the head 30 to 40 degrees contralateral to the side of the lesion and bending the neck forward, so that the approach was made laterally toward the ipsilateral suboccipital area. Eight patients with cerebellar hematoma underwent this stereotactic technique. Six patients complicated with intraventricular hemorrhage or obstructive hydrocephalus underwent simultaneously external ventricular drainage(EVD) via Kocher's point without position change. The mean amount of hematoma was 23.7ml (14~58ml). RESULTS: All showed initially a partial removal of the hematoma about 6.1ml in mean volume through stereotactically placed catheters and the residual hematoma was drained out by urokinase irrigation for mean of 3.3 days. The mean operation time took 2 hours in cases combined with EVD and one hour and half in cases not. CONCLUSION: This surgical technique for the cerebellar hematoma can be easily done in a supine position under local anesthesia and surgical invasion is minimal. It also has benefits that EVD can be done without any position change.

Key Words: Suboccipital lateral approach; Stereotactic technique; Cerebellar hematoma