BACKGROUND Guidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes. METHODS We searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and observational cohort studies. We included studies according to predefined selection criteria and assessed their quality according to the Newcastle-Ottawa Scale (NOS) and risk of bias according to a predefined scale. We assessed case fatality and functional outcome in patients treated conservatively or with haematoma evacuation. Favourable functional outcome was defined as a modified Rankin Scale score of 0-2 or a Glasgow Outcome Scale score of 4-5. RESULTS We included 41 observational cohort studies describing 2062 patients (40% female) with spontaneous cerebellar ICH. A total of 1171 patients (57%) underwent haematoma evacuation. Ten studies described a cohort of surgically treated patients (n=533) and 31 cohorts with both surgically and conservatively treated patients (n=638 and n=891, respectively). There were no randomised clinical trials nor studies comparing outcome between the groups after adjustment for differences in baseline characteristics. The median NOS score (IQR) was 5 (4-6) out of 8 points and the bias score was 2 (1-3) out of 8, indicative of high risk of bias. Case fatality at discharge was 21% (95% CI 17% to 25%) after conservative treatment and 24% (95% CI 19% to 29%) after haematoma evacuation. At ≥6 months after conservative treatment, case fatality was 30% (95% CI 25% to 30%) and favourable functional outcome was 45% (95% CI 40% to 50%) and after haematoma evacuation, case fatality was 34% (95% CI 30% to 38%) and 42% (95% CI 37% to 47%). CONCLUSIONS Controlled studies on the effect of neurosurgical treatment in patients with spontaneous cerebellar ICH are lacking, and the risk of bias in published series is high. Due to substantial differences in patient characteristics between conservatively and surgically treated patients, and high variability in treatment indications, a meaningful comparison in outcomes could not be made. There is no good published evidence to support treatment recommendations and controlled, preferably randomised studies are warranted in order to formulate evidence-based treatment guidelines for patients with cerebellar ICH.

中文翻译：

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小脑脑出血的血肿疏散：系统评价。

背景技术关于自发性小脑脑出血（ICH）的手术治疗建议的指南有所不同。我们旨在系统地回顾文献以评估治疗策略和结果。方法我们在1970年至2019年之间对PubMed和Embase进行了搜索，以寻找随机或其他对照研究和观察性队列研究。我们根据预定义的选择标准进行了研究，并根据纽卡斯尔-渥太华量表（NOS）评估了其质量，并根据预定义的量表评估了偏倚风险。我们评估了保守治疗或血液肿疏散治疗的患者的病死率和功能结局。良好的功能预后定义为改良的Rankin量表评分为0-2或格拉斯哥成果量表评分为4-5。结果我们纳入了41项观察性队列研究，描述了2062例自发性小脑ICH患者（女性占40％）。共有1171例患者（57％）进行了血肿疏散。十项研究描述了一组接受手术治疗的患者（n = 533）和31项接受手术和保守治疗的患者（分别为n = 638和n = 891）。校正基线特征差异后，尚无随机临床试验或比较两组间结局的研究。中位NOS得分（IQR）为8分中的5（4-6），偏差得分为8分中的2（1-3），表明存在偏见的风险很高。保守治疗后出院时病死率为21％（95％CI 19％至29％），而血肿清除后为24％（95％CI 19％至29％）。保守治疗后≥6个月，病死率为30％（95％CI 25％到30％），良好的功能预后为45％（95％CI 40％到50％），血肿清除后，病死率为34％（95％CI 30％到38） ％）和42％（95％CI 37％至47％）。结论缺乏对自发性小脑性脑出血患者神经外科治疗效果的对照研究，在已发表的系列文章中存在偏见的风险很高。由于保守治疗和手术治疗的患者在患者特征上存在显着差异，并且治疗适应症的差异很大，因此无法对结果进行有意义的比较。没有良好的公开证据支持治疗建议，必须进行对照研究，最好是进行随机研究，以便为小脑性ICH患者制定循证治疗指南。