Suboccipital craniotomy is a considerable surgical approach for large spontaneous cerebellar hemorrhage, but its prognostic has not been comprehensively addressed. This study aims to report the surgical outcomes and factors related to the prognosis of recovery and death within 1–6 months of patients with spontaneous cerebellar hemorrhage.

We retrospectively studied 37 patients who underwent craniotomy due to spontaneous cerebellar hemorrhage from January 2019 to April 2022.

The disease occurs at a mean age of 62.86 years old, with a male/female ratio of 4.26/1. Hemorrhage is mainly in the cerebellar hemisphere. Hospital stays averaged 13.32 days, with significant reductions in hematoma diameter and volume after surgery. The hospital mortality rate was 5.41 %, increasing to 45.95 % at 1 month post-discharge. Prognostic factors for death within 1 month include low Glasgow score, small hematoma diameter, and low hematoma volume. Factors associated with recovery include young age, absence of ventricle hemorrhage, and high Glasgow score.

Suboccipital craniotomy demonstrates a high efficacy in resolving hematomas with decreased complication rates, lower mortality, and improved patient recovery outcomes. Optimal surgical outcomes would be achieved with early intervention, particularly in younger patients.