1
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Sato S, Hayashi H, Urayama D, Ito Y, Naganuma H, Shinbori H. A Case of Remote Cerebellar Hemorrhage in Spinal Surgery without Dural Injury: Case Report. J Orthop Case Rep 2023; 13:38-41. [PMID: 37753124 PMCID: PMC10519310 DOI: 10.13107/jocr.2023.v13.i09.3868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Remote cerebellar hemorrhage (RCH) has been reported as a serious complication of spine surgery and is considered to be caused by dural injury. However, we have experienced a case in which intracranial hemorrhage occurred immediately after lumbar spine surgery without dural tear. There were no reports of RCH in spinal surgery without dural injury as far as we could find. Case Report We described a rare presentation of an 80-year-old male who suffered a loss of consciousness after lumbar surgery. He was diagnosed with impaired consciousness due to chronic and acute intracranial hemorrhage. He went through two hematoma removal surgeries and his consciousness improved. Conclusion RCH can occur in spinal surgery in patients with predicted cerebrovascular fragility, even in the absence of dural injury. Pre-operative imaging evaluation could be useful in assessing cerebrovascular fragility.
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Affiliation(s)
- Shinsuke Sato
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hiroshi Hayashi
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Daiki Urayama
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Yusuke Ito
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hidetoshi Naganuma
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hiroshi Shinbori
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
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2
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Al-Saadi T, Al-Kindi Y, Allawati M, Al-Saadi H. Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication. Surg J (N Y) 2022; 8:e98-e107. [PMID: 35252567 PMCID: PMC8894081 DOI: 10.1055/s-0042-1743525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction
Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning.
Aim
A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries.
Methods
A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed.
Results
A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%).
Conclusion
The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post–spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.
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Affiliation(s)
- Tariq Al-Saadi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital- McGill University, Montreal, Canada.,Neurosurgery Department, Khoula Hospital, Muscat, Sultanate of Oman
| | - Yahya Al-Kindi
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Moosa Allawati
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Hatem Al-Saadi
- Department of General Surgery, Sohar Hospital, Sohar, Sultanate of Oman
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3
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Al-Gethami H, Cenic A, Kachur E. Seizures following cervical laminectomy and lateral mass fusion: case report and review of the literature. JOURNAL OF SPINE SURGERY 2021; 7:445-455. [PMID: 34734149 DOI: 10.21037/jss-20-642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
Incidental durotomy can occur as a complication of spine surgery, which may potentially result in serious intracranial complications. We report a case of a 72 years old male with significant cervical spinal stenosis from C3 to C5 with spinal cord myelomalacia who underwent a posterior cervical decompression with instrumentation and fusion from C3-C5. An incidental dural tear was encountered during the surgery, with a sudden gush of cerebrospinal fluid (CSF) managed intraoperatively. Unfortunately, he developed generalized tonic-clonic seizures subsequently in the immediate post-operative period. Computerized tomography (CT) scan was urgently done which revealed intracranial pneumocephalus, subarachnoid hemorrhage and a right acute subdural hematoma. This case illustrates the intracranial hemorrhage potential subsequent to iatrogenic dural tear and CSF leak manifested by generalized seizures. The repair of incidental durotomy should be done immediately to decrease the amount of CSF leak and prevent any devastating effects of intracranial hemorrhage. The mechanism of this type of bleeding, risk factors and appropriate management are discussed, along with a review of the literature.
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Affiliation(s)
- Hanan Al-Gethami
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Edward Kachur
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
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4
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Tabibkhooei A, Mohsenian Sisakht A, Yassari M. Remote site hemorrhage mechanism, management and outcome? Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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5
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Lin GX, Chen CM, Kim JS, Song KS. The Transformation of Intracranial Subdural Hygroma to Chronic Subdural Hematoma Following Endoscopic Spinal Surgery: A Case Report. J Neurol Surg A Cent Eur Neurosurg 2021; 83:502-506. [PMID: 34261140 DOI: 10.1055/s-0041-1723812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We present the case of an intracranial subdural hygroma resulting from intraoperatively undetected dural tear after unilateral biportal endoscopic (UBE) spine surgery for lumbar spinal stenosis. CASE DESCRIPTION An 80-year-old woman presented with insidious onset, gradually progressing low back pain, and right leg pain of 1-year duration. The pain radiated to the right L4-L5 dermatomes. Neurogenic intermittent claudication was <300 m. Motor function was normal. Lumbar magnetic resonance imaging showed a lateral recess stenosis at the L3-L4 and L4-L5 levels. These lesions were operated on by the UBE decompression technique.No major complications were encountered during the operation. But soon we found out that there was an undiscovered dura tear. We placed the patient under close observation for 2 weeks. After 30 days, we confirmed that subdural hygroma had changed to chronic subdural hematoma. Conservative treatment was continued. On postoperative day 90), the condition was stable and the symptoms improved completely. CONCLUSIONS We concluded that a spinal cerebrospinal fluid leakage can result in an intracranial subdural hygroma. Intracranial subdural hygromas and hematomas after lumbar spinal surgery should be cautiously assessed and treated.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan-Su Song
- Department of Neurosurgery, Him Plus Hospital, Suncheon, Republic of Korea
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6
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Kumar S, Kale HA. Remote cerebellar haemorrhage: A case report. Indian J Radiol Imaging 2021; 30:521-523. [PMID: 33737786 PMCID: PMC7954161 DOI: 10.4103/ijri.ijri_123_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 09/01/2020] [Indexed: 12/03/2022] Open
Abstract
Intracranial haemorrhage after supra-tentorial craniotomies can occur in a typical pattern and location which may suggest the diagnosis of remote cerebellar haemorrhage (RCH) which is quite a rare occurrence. The ‘Zebra Sign’ refers to a pattern of hyperdensity indicative of blood and hypodensity indicative of normal cerebellar parenchyma in a curvilinear, stripe-like fashion along the cerebellar folia and is a characteristic imaging finding in RCH. RCH in general doesn't require surgical treatment, however in cases of significant hydrocephalus or progressive deterioration of consciousness surgical treatment may be warranted. The knowledge of this condition is important as it can pre-empt unnecessary further investigations and biopsy. Although imaging appearance may be striking, close imaging follow-up and clinical monitoring are often enough for the management of this entity.
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Affiliation(s)
- Sachin Kumar
- Department of Radiology, Kokilaben Dhirubhai Ambani Hopsital and Research Institute, Mumbai, Maharashtra, India
| | - Hrishikesh A Kale
- Department of Radiology, Kokilaben Dhirubhai Ambani Hopsital and Research Institute, Mumbai, Maharashtra, India
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Allouch H, Abu Nahleh K, Mursch K, Shousha M, Alhashash M, Boehm H. Symptomatic Intracranial Hemorrhage after Dural Tear in Spinal Surgery-A Series of 10 Cases and Review of the Literature. World Neurosurg 2021; 150:e52-e65. [PMID: 33640532 DOI: 10.1016/j.wneu.2021.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Intracranial hemorrhage (IH) after spinal surgery is a rare but potentially life-threatening complication. Knowledge of predisposing factors and typical clinical signs is essential for early recognition, helping to prevent an unfavorable outcome. METHODS A retrospective analysis was performed of patients with IH after spinal surgery treated in our institution between 2012 and 2018. The literature dealing with IH complicating spinal surgery was reviewed. RESULTS Our investigation found 10 patients with IH (6 female and 4 male). To the best of our knowledge, this is the largest series reported so far. The assumable incidence of IH after spinal surgery in our population was 0.0657%. Durotomy was noticed in 6 patients, all of whom were treated according to a local standard protocol. In 4 patients, the dural tear was occult. Hemorrhage occurred mostly in the cerebellar compartment. Eight of 10 patients had long-standing arterial hypertension, which seems to be a risk factor (hazard ratio, 1.58). Five patients were treated conservatively, whereas 3 required a cerebrospinal fluid (CSF) diversion procedure. In 2 patients, revision surgery with duraplasty was necessary. Seven patients were discharged with little to no neurologic symptoms, and 3 had significant deterioration. One patient died because of brainstem herniation. Review of the literature identified 54 articles with 72 patients with IH complicating spinal surgery. CONCLUSIONS Patients with intraoperative CSF loss should be kept under close supervision postoperatively. After opening of the dura, a watertight closure should be attempted. The use of subfascial suction drainage in cases of a dural tear as well as preexistent arterial hypertension seems to be a risk factor for the development of IH. Intracranial bleeding must be considered in every patient with unexplained neurologic deterioration after spinal surgery and should be ruled out by cranial imaging. To ensure early recognition and prevent an unfavorable outcome, a high index of suspicion is required, especially in revision spinal surgery. The treatment is specific to the extent and location of the IH, thus dictating the outcome. In most patients, conservative treatment led to a good outcome. CSF diversion measures may be necessary in patients with compression or obstruction of the fourth ventricle. Large hematomas with mass effect may require decompressive surgery.
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Affiliation(s)
- Hassan Allouch
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
| | - Kais Abu Nahleh
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Kay Mursch
- Department of Neurosurgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Mootaz Shousha
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany; Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
| | - Mohammed Alhashash
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany; Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
| | - Heinrich Boehm
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
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8
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Feng L, Han Y, Wang Y, Li G, Wang G. Remote medulla ablongata ventral acute subarachnoid hemorrhage following cervical spinal surgery: A case report. Int J Surg Case Rep 2021; 80:105675. [PMID: 33639502 PMCID: PMC7921496 DOI: 10.1016/j.ijscr.2021.105675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022] Open
Abstract
Remote intracranial hemorrhage (RICH) in patients during spinal surgery is rare. Our case was a man with subarachnoid hemorrhage due to cervical spinal surgery. The pathomechanism leading to RICH is probably due to rapid leak of CSF. Treatment for RICH depends on the size of hematoma and symptoms.
Introduction The incidence of remote intracranial hemorrhage (RICH) in patients during spinal surgery is rare and the detailed mechanism remains unclear. Presentation of case A 55-year-old man had undergone cervical discectomy and fusion at C5–6 and C6–7 due to herniated disc and secondary spinal canal stenosis. He had severe headache 20 h postoperatively and his drain output increased from 100 to 350 mL in the second 10 h after surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed and he was diagnosed with acute subarachnoid hemorrhage in the ventral medulla oblongata. The drainage tube was quickly removed. Infusion of hypertonic saline was used to reduce intracranial pressure and nimodipine prevented vasospasm around the brainstem. The patient made a gradual, satisfactory recovery with conservative treatment. Discussion The most likely pathomechanism leading to RICH is venous bleeding due to rapid leak of a large amount of cerebral spinal fluid (CSF) after spinal surgery. If the patient has a headache or neurological complaints after spinal surgery, immediate imaging is recommended to confirm the diagnosis. Treatment depends on the amount and location of intracranial hemorrhage. Conclusion RICH is a serious but rare complication of spinal surgery and cerebellar hemorrhage is the most common. The most important pathomechanism leading to RICH after spinal surgery is venous bleeding due to rapid leak of a large amount of CSF. Timely CT is necessary to exclude RICH. Treatment of RICH depends on the size of the intracranial hematoma and the patient’s symptoms.
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Affiliation(s)
- Lu Feng
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China
| | - Yanwu Han
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China
| | - Yanjuan Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China
| | - Guanglin Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China
| | - Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China.
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9
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Di L, Wei G, Eichberg DG, Komotar RJ, Ivan M. Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature. Cureus 2020; 12:e12082. [PMID: 33489500 PMCID: PMC7805504 DOI: 10.7759/cureus.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH. We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intra-operatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed. Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH.
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Affiliation(s)
- Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Grace Wei
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.,Neurological Surgery, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Michael Ivan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.,Neurological Surgery, Sylvester Comprehensive Cancer Center, Miami, USA
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10
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Kinthala S, Jiao K, Ankam A, Paramore CG. Cerebellar Hemorrhage and Spinal Fluid Overdrainage With Tonsillar Herniation Following Spine Surgery. Cureus 2020; 12:e10418. [PMID: 33062533 PMCID: PMC7553715 DOI: 10.7759/cureus.10418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spinal fluid overdrainage with cerebellar hemorrhage is a rare complication of spinal surgery that can have severe consequences if not detected quickly. We present the case of a 72-year-old Caucasian female who underwent thoracolumbar fixation for flatback syndrome. Intraoperatively, the patient suffered a dural injury that was repaired. In the immediate postoperative period, the patient’s neurological status rapidly deteriorated within an hour and Jackson-Pratt (JP) drain output measured 300 ml of serosanguinous fluid. A stat CT scan revealed cerebellar hemorrhage, pneumocephalus, and tonsillar herniation. The postoperative drain was immediately removed, and a ventriculostomy tube was placed, confirming low intracranial pressure. Postoperatively, the patient was electively ventilated for three days, continued with remote cerebellar hemorrhage (RCH) treatment and precaution, and extubated on the third day as the patient’s neurological function continued to improve. The patient was discharged home nine days after the initial surgery, with a complete recovery. This case indicates that wound drainage in the face of durotomy can induce cerebellar herniation as early as within an hour postoperatively following spine surgery with a dural tear, even after dural repair. This case also suggests that early recognition and appropriate management of RCH is the key to a full recovery. Even in the event of tonsillar herniation and cerebellar hemorrhage, a complete recovery is possible with early recognition and proper management.
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Affiliation(s)
| | - Kuiran Jiao
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
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11
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Lim KZ, Daly C, Brown J, Goldschlager T. Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression. Global Spine J 2019; 9:575-582. [PMID: 31448189 PMCID: PMC6693074 DOI: 10.1177/2192568218811317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Evidence on predicting the success of indirect decompression via extreme lateral interbody fusion (XLIF) is scarce. The authors investigated if patients who could achieve a pain-free position preoperatively would derive clinical benefit from XLIF without direct decompression. METHODS Data from 50 consecutive patients who underwent XLIF with and without direct decompression by a single surgeon from January 2014 to August 2017 was collected. Primary outcome is the rate of failure of patients who underwent XLIF without direct decompression, characterized by persistence of pain postoperatively that required reoperations within 6 months postoperatively. Secondary outcomes are clinical outcomes and patient-reported quality of life outcome data, including visual analogue scale for leg (VASL) and back (VASB) pain, Oswetry Disability Index (ODI), and Physical Component Score (PCS) and Mental Component Score (MCS) of SF-12, for up to 2 years postoperatively. RESULTS One patient with preoperative dynamic posture-related pain who underwent XLIF without direct decompression subsequently had a reoperation due to persisting pain. Statistically significant improvement was achieved across all patient reported outcomes (P < .05): improvement of 68% for VASL, 61% for VASB, 50% for ODI, 33% for PCS, and 11% for MCS of SF-12 at last follow-up. Six patients had thigh symptoms that resolved. CONCLUSION The simple clinical criterion based on postural pain status preoperatively may help clinicians in patient selection for indirect decompression of XLIF without the need for direct decompression. Further studies with larger cohorts are warranted to establish the validity of the algorithm.
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Affiliation(s)
- Kai-Zheong Lim
- Department of Neurosurgery, Monash Health, Melbourne, Victoria,
Australia,Department of Surgery, Monash University, Melbourne, Victoria,
Australia,Kai-Zheong Lim, Department of Neurosurgery, Monash
Health, 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
| | - Christopher Daly
- Department of Neurosurgery, Monash Health, Melbourne, Victoria,
Australia,Hudson Institute of Medical Research, The Ritchie Centre, Melbourne,
Victoria, Australia
| | - Jessica Brown
- Department of Surgery, Monash University, Melbourne, Victoria,
Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Victoria,
Australia,Department of Surgery, Monash University, Melbourne, Victoria,
Australia,Hudson Institute of Medical Research, The Ritchie Centre, Melbourne,
Victoria, Australia
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12
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Worm PV, Dalla-Corte A, Brasil AVB, Perondi G, Sfreddo E, Vial ADM, Gago G, da Costa PRF. Cerebellar hemorrhage as a complication of spine surgery. Surg Neurol Int 2019; 10:85. [PMID: 31528423 PMCID: PMC6744776 DOI: 10.25259/sni-121-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/15/2019] [Indexed: 11/04/2022] Open
Abstract
Background The association between remote cerebellar hematoma (RCH) and spinal surgery is poorly understood and rarely reported. We present seven cases of RCH after spinal surgery. Methods Seven patients were diagnosed with RCH utilizing computed tomography and/or magnetic resonance, between 2012 and 2016. Their clinical presentations, imaging data, treatment modalities, and outcome were analyzed. There were five females and two males with an average age of 55.8 ± 8.4 years. The age of onset ranged from 43 to 67 years and the time to clinical presentation ranged from 3 h to 5 days. Patients presented with: diplopia/strabismus (one patient), dysphagia/urinary incontinence (one patient), respiratory arrest (one patient), meningismus (one patient), and dysarthria (two patients), along with other symptoms/signs. Results Three patients were successfully managed without surgery, two required external ventricular drainage, and two were treated with posterior fossa decompression plus ventriculostomy. Four patients recovered completely, two showed mild residual deficits at discharge, while one expired 7 days postoperatively. Conclusion RCH is an uncommon and underdiagnosed complication of spine surgery. It should be suspected when intracranial symptoms occur after spinal procedures.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Neurological Surgery, Sao Jose Hospital, Santa Casa Hospital Complex, RS, Brazil.,Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | - Amauri Dalla-Corte
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | | | - Gerson Perondi
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | - Ericson Sfreddo
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | | | - Guilherme Gago
- Department of Neurological Surgery, Sao Jose Hospital, Santa Casa Hospital Complex, RS, Brazil
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13
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Berry B, Ghannam M, Bell C, Ghazaleh S, Boss S, Streib C, Ezzeddine M. Basal ganglia hemorrhage in a case report following spinal surgery. BMC Neurol 2018; 18:204. [PMID: 30547770 PMCID: PMC6293582 DOI: 10.1186/s12883-018-1218-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intracranial hemorrhage is a rare but potentially severe complication of spinal surgery. Most reported post-operative ICH cases consist of cerebellar hemorrhage. There are fewer reported cases of supratentorial ICH following spinal surgery. CASE PRESENTATION A 56-year-old woman underwent spinal surgery complicated by bilateral supratentorial intraparenchymal basal ganglia hemorrhage with both intraventricular extension and subarachnoid hemorrhage in both cerebral hemispheres. CONCLUSION The occurrence of neurological deterioration post-operatively following spinal surgery should alert physicians to the possibility of intracranial hemorrhage in order to facilitate rapid and optimal management. To our knowledge, this is the first case reporting basal ganglia hemorrhage following spinal surgery. Moreover, consideration should be given to the possibility of this complication prior to recommendation of elective spinal surgery.
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Affiliation(s)
- Brent Berry
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | - Malik Ghannam
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | | | - Sami Ghazaleh
- Internal Medicine Department, University of Toledo, Toledo, OH USA
| | - Sherief Boss
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | | | - Mustapha Ezzeddine
- Neurosurgery and Radiology, Neurology Department, University of Minnesota, Minneapolis, MN USA
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14
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Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery. Case Rep Neurol Med 2018; 2018:5870584. [PMID: 30305969 PMCID: PMC6165595 DOI: 10.1155/2018/5870584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/26/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome.
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15
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Val-Jordán E, Seral-Moral P, Novo-González B. Remote cerebellar hemorrhage caused by undetected dural tear after lumbar spinal surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Kondo Y, Fushimi K, Takasawa M, Kanamori S, Miyagawa T, Kawashima K, Yokoyama K, Akiyama H. Intracranial subarachnoid hemorrhage following cervical laminoplasty: a report of two cases. Int J Neurosci 2018; 128:878-880. [DOI: 10.1080/00207454.2018.1426575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Yuichi Kondo
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Orthopaedic Surgery, Spine Center, Gifu Municipal Hospital, Gifu, Japan
| | - Kazunari Fushimi
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Makoto Takasawa
- Department of Orthopaedic Surgery, Spine Center, Kizawa Memorial Hospital, Minokamo City, Japan
| | - Shigeo Kanamori
- Department of Orthopaedic Surgery, Spine Center, Kizawa Memorial Hospital, Minokamo City, Japan
| | - Takaki Miyagawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Kawashima
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazutoshi Yokoyama
- Department of Neurosurgery, Kizawa Memorial Hospital, Minokamo City, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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17
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Al Safatli D, Guenther A, McLean AL, Waschke A, Kalff R, Ewald C. Prediction of 30-day mortality in spontaneous cerebellar hemorrhage. Surg Neurol Int 2017; 8:282. [PMID: 29279799 PMCID: PMC5705929 DOI: 10.4103/sni.sni_479_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/30/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Cerebellar hemorrhage is a potentially life-threatening condition and an understanding of the factors influencing outcome is essential for sound clinical decision-making. Methods: We retrospectively evaluated data from 50 consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) from 2005 to 2014, analysing their short-term outcomes and identifying possible clinical, radiological and therapeutic risk factors for poor prognosis and death within 30 days. Results: Among 50 patients with first SCH, the mean age was 72 ± 10 years. Median Glasgow Coma Scale (GCS) score on admission was 11 [interquartile range (IQR) = 7–11]. Among 50 patients, 19 patients (38%) underwent surgical hemorrhage evacuation with placement of an external ventricular drain (EVD), 12 patients (24%) received an EVD only and 19 patients (38%) were treated conservatively. The 30-day mortality rate was 36%. In multivariate analysis only the GCS score on admission was a significant predictor of 30-day mortality [odds ratio (OR) = 0.598; 95% confidence interval (CI) = 0.406–0.879; P = 0.009]. For prediction of 30-day mortality, receiver operating characteristic curve analysis confirmed that the best cut-off point was a GCS score of 10 on admission [area under the curve: 0.882, 95% CI = 0.717–1, P < 0.001]. Conclusion: Lower GCS score on admission was associated with increased 30-day mortality and poorer short-term outcome in patients with SCH. For patients with a GCS score <10 on admission, it is important to balance the possibility of survival afforded by further therapy against the formidable risk of significant functional disability and poor quality of life.
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Affiliation(s)
- Diaa Al Safatli
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Albrecht Guenther
- Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Albrecht Waschke
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Rolf Kalff
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Christian Ewald
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany
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Val-Jordán E, Seral-Moral P, Novo-González B. Remote cerebellar hemorrhage caused by undetected dural tear after lumbar spinal surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:228-230. [PMID: 28882465 DOI: 10.1016/j.recot.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/08/2017] [Accepted: 06/21/2017] [Indexed: 12/01/2022] Open
Abstract
Remote cerebellar haemorrhage is a rare but serious complication after spinal surgery. Although the mechanism is not well known, it always occurs after loss of cerebrospinal fluid due to dural tear, not always identified, which produces remote venous bleeding. Prognosis depends largely on the severity of this bleeding. We report a case of 67-year-old female who suffered a cerebellar and subarachnoid haemorrhage and subdural haematoma after elective lumbar fusion surgery and eventually required decompressive craniectomy.
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Affiliation(s)
- Estela Val-Jordán
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Pilar Seral-Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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19
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Chan AY, Mullin JP, Benzel E, Bingaman W. Immediate Remote Cerebellar Hemorrhage and Seizure Following Revision Lumbosacral Fusion. Cureus 2017; 9:e1292. [PMID: 28680780 PMCID: PMC5493455 DOI: 10.7759/cureus.1292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebellar hemorrhage (CH) is a rare but devastating complication following spine surgery. It is associated with a compromise to dura integrity and typically has a delayed post-operative onset. Here, we describe a patient who suffered a CH that presented with a generalized tonic-clonic (GTC) seizure immediately after a revision lumbar fusion. The patient did not regain consciousness from anesthesia prior to the hemorrhage. There are no reports indicating that CHs can occur abruptly following a spine surgery. This case outlines the importance of remaining vigilant for signs of CH immediately after surgery.
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20
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Sen HM, Guven M, Aras AB, Cosar M. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report. J Korean Neurosurg Soc 2017; 60:367-370. [PMID: 28490165 PMCID: PMC5426457 DOI: 10.3340/jkns.2014.0709.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022] Open
Abstract
Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.
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Affiliation(s)
- Halil Murat Sen
- Department of Neurology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale,
Turkey
| | - Mustafa Guven
- Department of Neurosurgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale,
Turkey
| | - Adem Bozkurt Aras
- Department of Neurosurgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale,
Turkey
| | - Murat Cosar
- Department of Neurosurgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale,
Turkey
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21
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Gürbüz MS, Karaarslan N, Gök S, Soyalp C. Remote Cerebellar Haemorrhage after Burr Hole Drainage of Chronic Subdural Haematoma: A Case Report. J Clin Diagn Res 2016; 10:PD01-2. [PMID: 27437296 DOI: 10.7860/jcdr/2016/17218.7710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
Remote cerebellar haemorrhage (RCH) is an unusual complication of supratentorial neurosurgical procedures. Even the rarer is cerebellar haemorrhage occurring after supratentorial burr hole drainage of Chronic Subdural Haematoma (CSDH). The exact mechanism is still unclear despite some possible causative factors such as rapid evacuation of haematoma and overdrainage of CSF (Cerebrospinal Fluid). We report a 80-year-old male patient who developed cerebellar haemorrhage after burr hole drainage of left frontoparietal chronic subdural haematoma and discuss the possible aetiological mechanisms through the review of the current literature.
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Affiliation(s)
| | - Numan Karaarslan
- Faculty, Department of Neurosurgery, Namık Kemal University Medical Faculty , Tekirdag, Turkey
| | - Sevki Gök
- Faculty, Department of Neurosurgery, Kars Public Hospital , Kars, Turkey
| | - Celaleddin Soyalp
- Faculty, Department of Anesthesiology, Agrı Public Hospital , Agrı, Turkey
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22
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Yılmaz B, Işık S, Ekşi MŞ, Ekşi EEÖ, Akakın A, Toktaş ZO, Konya D. Multiple hemorrhages in brain after spine surgery supra- and infra-tentorial components together. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:223-6. [PMID: 26692705 PMCID: PMC4660504 DOI: 10.4103/0974-8237.167890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Remote cerebellar hemorrhage after cranial and spinal surgeries is a well-documented entity, so far concomitant supra- and infra-tentorial hemorrhage after spine surgery has rarely been reported in the literature. A 57-year-old woman presented with intractable low back pain and severely impaired mobility. One year ago, she underwent lumbar laminectomy and fusion with posterior spinal instrumentation between L2 and S1. She developed adjacent segment disease at the upper level of the instrumented vertebra. She had a revision surgery and underwent posterior laminectomy and fusion with bilateral transpedicular instrumentation between T10 and S1. She had severe headache, somnolence, and left hemiparesia 48 h after the surgery. Her emergent head computed tomography depicted intra-parenchymal hemorrhage in the right parietal lobe accompanying with subarachnoid hemorrhage, bilateral symmetrical cerebellar hemorrhages and pneumocephalus. She was treated nonsurgically and she got better despite some residual deficits. Symptoms including constant headache, nausea, vomiting, impaired consciousness, new onset seizure, and focal neurological deficit after spine surgeries should raise suspicion for intracranial intra-parenchymal hemorrhage.
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Affiliation(s)
- Baran Yılmaz
- Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey
| | - Semra Işık
- Department of Neurosurgery, Hakkari State Hospital, Hakkari, Turkey
| | - Murat Şakir Ekşi
- Department of Orthopaedic Surgery, Spine Center, University of California at San Francisco, CA, USA
| | - Emel Ece Özcan Ekşi
- Department of Orthopaedic Surgery, Spine Center, University of California at San Francisco, CA, USA
| | - Akın Akakın
- Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey
| | - Zafer Orkun Toktaş
- Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey
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Sturiale CL, Rossetto M, Ermani M, Baro V, Volpin F, Milanese L, Denaro L, d’Avella D. Remote cerebellar hemorrhage after spinal procedures (part 2): a systematic review. Neurosurg Rev 2015; 39:369-76. [DOI: 10.1007/s10143-015-0673-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/09/2015] [Indexed: 01/30/2023]
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24
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Paulson D, Page J, Moisi MD, Oskouian RJ. Commentary on: "Remote Cerebellar Hemorrhage after Revision Lumbar Spine Surgery". Global Spine J 2015; 5:538. [PMID: 26682109 PMCID: PMC4671894 DOI: 10.1055/s-0035-1567837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- David Paulson
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Jeni Page
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Marc D. Moisi
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, United States,Address for correspondence Marc D. Moisi, MD Department of Neurosurgery, Swedish Neuroscience Institute550 17th Avenue, Seattle, WA 98122United States
| | - Rod J. Oskouian
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, United States
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25
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Haller JM, Calvert G, Spiker WR, Brodke DS, Lawrence BD. Remote Cerebellar Hemorrhage after Revision Lumbar Spine Surgery. Global Spine J 2015; 5:535-7. [PMID: 26682108 PMCID: PMC4671890 DOI: 10.1055/s-0035-1567839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Study Design Case report. Objective To report a case of remote cerebellar hemorrhage (RCH) without intraoperative dural tear after revision lumbar spine surgery. RCH is a rare postoperative complication following spine surgery. RCH has previously been reported only in cases with intraoperative dural tear or durotomy. Methods Case report and literature review. Results A 58-year-old woman underwent removal of L4-S1 posterior spinal instrumented fusion (PSIF) implants and L3-L4 decompressive laminectomy with PSIF. There was no intraoperative dural tear. After doing well initially, the patient developed new neurologic symptoms and was found to have RCH. Lumbar spine magnetic resonance imaging (MRI) demonstrated a large dural defect. After repair of the dura, the patient had dramatic improvement of her neurologic symptoms. At 1-year follow-up, the patient continued to have no neurologic sequelae. Conclusion This report demonstrates that RCH can occur without intraoperative dural tear. Although rare, any patient with new onset of declining neurologic symptoms following spine surgery should have a brain MRI and should have RCH on the differential diagnosis.
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Affiliation(s)
- Justin M. Haller
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States
| | - Graham Calvert
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, United States
| | - William R. Spiker
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States
| | - Darrel S. Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States
| | - Brandon D. Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States,Address for correspondence Brandon D. Lawrence, MD Department of Orthopaedics, University of Utah590 Wakara Way, Salt Lake City, UT 84108United States
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26
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Kim JY, Kim DK, Yoon SH. Remote Cerebellar Hemorrhage after Surgery for Degenerative Lumbar Spine Disease: A Case Report. Korean J Neurotrauma 2015; 11:201-4. [PMID: 27169095 PMCID: PMC4847508 DOI: 10.13004/kjnt.2015.11.2.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022] Open
Abstract
Spine surgery has been increased as the population ages, but the occurrence of unusual complication such as remote cerebellar hemorrhage (RCH) is not well understood. We recently experienced a case of RCH in a 60-year-old woman showed neurologic dysfunction after degenerative lumbar spine surgery. There was no definite dural tearing and cerebrospinal fluid (CSF) loss during operation. Brain magnetic resonance imaging showed cerebellar hemorrhage. The patient received conservative management and rehabilitation program. Most other reports have been suggested that RCH after spinal surgery might be related with excessive CSF drainage perioperatively. Minimizing of CSF loss during operation would be helpful to reduce the risk of RCH. If large volume of CSF has been lost accompanied by neurologic deterioration, brain imaging is necessary simultaneously.
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Affiliation(s)
- Ji Yong Kim
- Department of Neurosurgery, Inha University College of Medicine, Inha University Hospital, Incheon, Korea
| | - Do Keun Kim
- Department of Neurosurgery, Inha University College of Medicine, Inha University Hospital, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Inha University Hospital, Incheon, Korea
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27
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Pham MH, Tuchman A, Platt A, Hsieh PC. Intracranial complications associated with spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:888-94. [DOI: 10.1007/s00586-015-4241-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/04/2015] [Accepted: 09/10/2015] [Indexed: 01/29/2023]
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28
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Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery. Case Rep Orthop 2015; 2015:972798. [PMID: 26339517 PMCID: PMC4538974 DOI: 10.1155/2015/972798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022] Open
Abstract
Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.
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29
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Abstract
A 65-year-old woman became obtunded following routine laminectomy and was found to have bilateral cerebellar haemorrhage and convexity subarachnoid haemorrhage. We discuss the possible mechanisms of remote cerebellar haemorrhage—cerebellar haemorrhage that develops after spinal or intracranial surgery—giving rise to the ’zebra sign' and the possible mechanism of convexity subarachnoid haemorrhage in this context [corrected].
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Affiliation(s)
- A Nagendran
- Department of Neurology, St George's Hospital NHS Foundation Trust, Tooting, UK
| | - B Patel
- Department of Neurology, St George's Hospital NHS Foundation Trust, Tooting, UK
| | - U Khan
- Department of Neurology, St George's Hospital NHS Foundation Trust, Tooting, UK
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30
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Floman Y, Millgram MA, Ashkenazi E, Rand N. Remote Cerebellar Hemorrhage Complicating Unintended Durotomy in Lumbar Spine Surgery. Int J Spine Surg 2015; 9:29. [PMID: 26273547 DOI: 10.14444/2029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years. OBJECTIVES To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage. SUMMARY AND BACKGROUND DATA Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH). METHODS During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. RESULTS Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients. CONCLUSIONS Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery.
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Affiliation(s)
- Yizhar Floman
- Israel Spine Center at Assuta Hospital, Tel Aviv, Israel
| | | | - Ely Ashkenazi
- Israel Spine Center at Assuta Hospital, Tel Aviv, Israel
| | - Nahshon Rand
- Israel Spine Center at Assuta Hospital, Tel Aviv, Israel
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31
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Suzuki M, Kobayashi T, Miyakoshi N, Abe E, Abe T, Shimada Y. Remote cerebellar hemorrhage following thoracic spinal surgery of an intradural extramedullary tumor: a case report. J Med Case Rep 2015; 9:68. [PMID: 25889850 PMCID: PMC4378378 DOI: 10.1186/s13256-015-0541-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/03/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction Remote cerebellar hemorrhage is a rare complication of spinal surgery. Although loss of cerebrospinal fluid seems to play an important role in the pathogenesis of this complication, the detailed mechanism of remote cerebellar hemorrhage after spinal surgery remains unclear. We report the case of a patient with remote cerebellar hemorrhage following thoracic spinal surgery of an intradural extramedullary tumor and discuss this entity with reference to the literature. Case presentation A 57-year-old Japanese woman presented to our hospital with back pain, dysuria, and numbness of both legs. A neurological examination was performed, and imaging was performed with ordinary radiography, magnetic resonance imaging, and computed tomography. Her magnetic resonance imaging scan showed an intradural extramedullary tumor at the T3 level. A tumor resection and T1-T5 pedicle screw fixation were performed. Twelve hours after spinal surgery, she complained of unexpected dizziness, nausea, and vomiting. A total of 850mL of serosanguineous fluid had been drained at that time, and drainage was stopped. An urgent brain computed tomography scan showed a cerebellar hemorrhage. She was treated conservatively, and was able to leave hospital six weeks after the initial operation, without any neurological deficits except for slight ataxia. Conclusions Remote cerebellar hemorrhage has to be suspected when unexpected neurological signs occur after spinal surgery. If an excessive amount of cerebrospinal fluid drains from the drainage tube after spinal surgery, drainage should be stopped.
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Affiliation(s)
- Masazumi Suzuki
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
| | - Takashi Kobayashi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Eiji Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
| | - Toshiki Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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32
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Yoon SJ, Hong CK. Remote Cerebellar Infarction after Supratentorial Craniotomy and Its Management: Two Case Reports. Brain Tumor Res Treat 2015; 3:141-6. [PMID: 26605273 PMCID: PMC4656893 DOI: 10.14791/btrt.2015.3.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/05/2015] [Accepted: 09/02/2015] [Indexed: 11/20/2022] Open
Abstract
The cerebellar infarction resulting from supratentorial craniotomy is uncommon event and its management has been controversial. After removal of space occupying lesion on right frontal area, two cases of remote cerebellar infarctions occurred. We reviewed each cases and the techniques to manage such complications are discussed. Early extraventricular catheter insertion and midline suboccipital craniectomy were effectively performed in obtunded patients from cerebellar infarction.
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Affiliation(s)
- Seon-Jin Yoon
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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33
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Abstract
Remote cerebellar haemorrhage (RCH) is a rare but potentially lethal complication of spinal surgery resulting from inadvertent opening of the dura. The precise mechanism of this type of haemorrhage remains undetermined. Magnetic resonance imaging (MRI) may show a ‘Zebra sign’ representing the horizontal curvilinear configuration of haemorrhage between the
cerebellar folia.
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34
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Mallio CA, Sarà M, Pistoia ML, Occhicone F, Errante Y, Giona A, Zobel BB, Quattrocchi CC. Bilateral remote cerebellar haemorrhage after spinal surgery: A case study and review of the literature. Brain Inj 2014; 28:1216-22. [DOI: 10.3109/02699052.2014.919524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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35
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Supratentorial subdural hemorrhage of a previous head injury and cerebellar hemorrhage after cervical spinal surgery: a case report and review of the literature. Spine (Phila Pa 1976) 2014; 39:E743-7. [PMID: 24718071 DOI: 10.1097/brs.0000000000000323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report a case of an acute supratentorial subdural hemorrhage (SDH) of a previous head injury site and cerebellar hemorrhage, after an incidental dural tear during spine surgery. SUMMARY OF BACKGROUND DATA Intracranial hemorrhage, such as subdural, cerebellar, subarachnoid, and epidural hemorrhage after a dural tear during spinal surgery, is a rare and poorly recognized complication. Moreover, only 3 cases in patients with concurrent SDH and cerebellar hemorrhage have been described in the literature, and none of these reports demonstrated the bleeding point on the adhesion site of the dural at the regions of the previous head injury. METHODS A case report and literature review are presented. RESULTS A 46-year-old male underwent occipital cervical surgery for os odontoideum. Intraoperatively, a dural tear was noted and repaired, but he later developed postoperative disturbance of consciousness. A head computed tomographic scan revealed a supratentorial SDH and cerebellar hemorrhage. Evacuation of the supratentorial SDH was performed via craniotomy, and the bleeding point was revealed to be on the adhesion site of the dural where the patient had experienced a previous head injury. The patient made a full recovery. CONCLUSION This report illustrates that cerebrospinal fluid leakage after a dural tear during spinal surgery may cause intracranial hemorrhage. A previous head trauma could be a risk factor for such hemorrhagic complications. Headache, nausea, and postoperative stupor after spinal surgery, especially after an accidental durotomy, should be considered possible indications of intracranial hemorrhage, and affected patients should be investigated with computed tomography or magnetic resonance imaging. LEVEL OF EVIDENCE N/A.
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Chauvet D, Silhouette B, Engrand N, Pradier F, Piotin M, Lot G. Multiple Spinal Hemangioblastomas Complicated with Postoperative Remote Cerebellar Hemorrhage: Review of the Literature of Two Rare Entities. World Neurosurg 2014. [DOI: 10.1016/j.wneu.2012.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Leung GKK, Chan JPH. Supratentorial Intraparenchymal Haemorrhages during Spine Surgery. J Korean Neurosurg Soc 2014; 55:103-5. [PMID: 24653806 PMCID: PMC3958572 DOI: 10.3340/jkns.2014.55.2.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 06/26/2013] [Accepted: 01/10/2014] [Indexed: 11/27/2022] Open
Abstract
Intracranial haemorrhages are rare but potentially life-threatening complications of spine surgery. Most reported cases involved subdural or cerebellar haemorrhages; supratentorial parenchymal bleeding is very uncommon. We report a 28-year-old woman who underwent resection of a thoracic Ewing's sarcoma, and developed fatal haemorrhages around her cerebral metastases during surgery. The clinical presentations, possible pathogenesis and potential preventive measures are discussed. Patients with disseminated metastases within the neural axis are at risks of intracranial complications during spine surgery. The presence of intracranial mass lesions should be considered as a relative contraindication to intradural spine surgery.
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Affiliation(s)
- Gilberto Ka Kit Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Johnny Ping Hon Chan
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Abstract
Imaging of the postoperative spine is common, although it remains a difficult task for radiologists. This article presents an overview of common surgical approaches and spinal hardware, and specific complications that may be associated with each procedure. In addition, expected postoperative changes and complications that are common among procedures, with their differential diagnosis and imaging features, are discussed.
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Affiliation(s)
- Morgan C Willson
- Department of Radiology, Foothills Medical Center, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
| | - Jeffrey S Ross
- Neuroradiology Department, Barrow Neurologic Institute, St Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Royon V, Rabehenoina C, Tourrel F, Compère V, Dureuil B. Remote cerebellar hemorrhage as an early and potentially lethal complication of a discal lumbar herniation surgery. ACTA ACUST UNITED AC 2014; 33:e19-21. [PMID: 24439492 DOI: 10.1016/j.annfar.2013.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022]
Abstract
Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery.
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Affiliation(s)
- V Royon
- Département d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - C Rabehenoina
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Rouen, 76031 Rouen, France
| | - F Tourrel
- Département d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - V Compère
- Département d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Dureuil
- Département d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Remote cerebellar haemorrhage after lumbar spine surgery: case report. Arch Orthop Trauma Surg 2013; 133:1645-8. [PMID: 24121622 DOI: 10.1007/s00402-013-1867-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 12/19/2022]
Abstract
Remote cerebellar haemorrhage (RCH) is a well-described complication of supratentorial surgical procedures with an incidence ranging between 0.2 and 4.9 %, but is a rare complication of spinal surgery. We report a case of RCH in a 65-year-old woman who showed sudden mental deterioration 48 h after lumbar spinal surgery, which was complicated by incidental dural tearing with minimal CSF loss. Brain CT scan revealed hypodense areas compatible with acute infarction involving mostly the left cerebellar hemisphere. No cerebral bleeding was observed. MRI was also performed revealing small cerebellar areas of acute infarction mainly relating the vermis and the left postero-inferior cerebellar hemisphere with haemorrhagic transformation and mass effect in the posterior fossa producing acute hydrocephalus. Haematoma removal was initially attempted by means of a suboccipital craniotomy. An external ventricular derivation was placed in a second procedure 24 h later due to the persistence of ventricular dilatation. At discharge the patient was only showing a slight dysmetria with the fine motor skills of hands and fingers. All cases of RCH after spinal surgery reported in the literature are invariably associated to iatrogenic dural tearing; although CSF loss seems to play the key role in the pathogenesis of this rare complication, the exact pathophysiology of this condition still remains undetermined.
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Kaloostian PE, Kim JE, Bydon A, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF. Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013; 19:370-80. [PMID: 23848351 DOI: 10.3171/2013.6.spine12863] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECT The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome. METHODS The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery. RESULTS The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period. CONCLUSIONS Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome.
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Affiliation(s)
- Paul E Kaloostian
- Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Chen Z, Zhang X, Jiang Y, Wang S. Delayed emergence from anesthesia resulting from bilateral epidural hemorrhages during cervical spine surgery. J Clin Anesth 2013; 25:244-5. [PMID: 23523980 DOI: 10.1016/j.jclinane.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/07/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
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Yoo JC, Choi JJ, Lee DW, Lee S. Remote cerebellar hemorrhage after intradural disc surgery. J Korean Neurosurg Soc 2013; 53:118-20. [PMID: 23560178 PMCID: PMC3611056 DOI: 10.3340/jkns.2013.53.2.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/13/2012] [Accepted: 02/04/2013] [Indexed: 12/02/2022] Open
Abstract
We report a rare case of remote cerebellar hemorrhage after intradural disc surgery at the L1-2 level. Two days after the spine surgery, patient complained unexpected headache, dizziness, nausea and vomiting. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage. Occipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed. After occipital craniotomy, the patient showed signs of improvement on headache, dizziness, nausea and vomiting. He was able to leave the hospital after two weeks of initial operation without any neurological deficit. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur from dural damage of spinal surgery, accompanied with cerebrospinal fluid leakage. Early diagnosis is particularly important for the optimal treatment of remote cerebellar hemorrhage.
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Affiliation(s)
- Je Chul Yoo
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
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Li D, Fu C, Xu D, Sun L, Yu W, Zhao C. Remote peritentorial hemorrhage complicating supratentorial aneurysmal surgery: a report of three cases and literature review. Acta Neurochir (Wien) 2013; 155:271-6. [PMID: 23108561 DOI: 10.1007/s00701-012-1540-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/18/2012] [Indexed: 12/24/2022]
Abstract
We herein coin the term "remote peritentorial hemorrhage (RPTH)" and present three cases with "RPTH" after supratentorial aneurysmal surgeries, including two with remote cerebellar hemorrhage (RCH) and one with remote temporobasal hemorrhage. The RCH may result from rupture of the superior cerebellar veins due to excessive cerebrospinal fluid (CSF) loss. The mechanism behind the remote temporobasal hemorrhage may be similar to that of RCH. It can be explained by tearing of the temporobasal veins as a result of brain shift owing to intracranial hypotension stemming from intensive loss of CSF. As far as we know, this is the first report of such a bleeding pattern of probable venous origin. The results of this study could shed light on the "RPTH" physiopathology.
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Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided epidural blood patch. J Neurosurg Anesthesiol 2012; 24:222-5. [PMID: 22614041 DOI: 10.1097/ana.0b013e31825749ee] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A persistent cerebrospinal fluid leak after spinal surgery can be associated with both meningitis and/or pneumocephalus. Therefore, early active intervention is recommended with surgical exploration, lumbar subarachnoid drain, and less commonly epidural blood patch. In the absence of a ligamentum flavum, the use of high-resolution ultrasound (US) spine imaging enables real-time advancement of a Tuohy needle towards the dura and the precise injection of blood to cover the dural defect. METHODS Six patients, after lumbar spine surgery with instrumentation and primary closure was complicated by incidental dural tears, developed severe symptomatic headaches that failed conservative therapy. All patients underwent US-guided epidural blood patch. Precise needle advancement to the dura was observed with US guidance, and 4-dimensional US scanning was used to confirm the expansion of blood over the dura in real time. RESULTS All patients had symptomatic relief of their headaches and successful treatment of dural leaks using US-guided blood patch. CONCLUSIONS Real-time US guidance allowed accurate positioning of the Tuohy needle and deposition of the epidural blood patch in the setting of a surgically removed ligamentum flavum. Further investigations are needed to confirm that an US-guided epidural blood patch may offer reliable symptomatic relief to postsurgical persistent cerebrospinal fluid leak and may serve as an intermediate step along a spectrum between conservative initial management and surgical reexploration.
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Wu JC, Chen YC, Liu L, Huang WC, Thien PF, Chen TJ, Cheng H, Lo SS. Lumbar spine fusion surgery and stroke: a national cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:2680-7. [PMID: 22722922 DOI: 10.1007/s00586-012-2405-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 05/02/2012] [Accepted: 06/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the incidence and risk of stroke after lumbar spinal fusion surgery. METHOD Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed. RESULTS The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance. CONCLUSIONS Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.
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Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Wu JC, Chen YC, Liu L, Chen TJ, Huang WC, Thien PF, Cheng H, Lo SS. The risk of stroke after spinal fusion surgery: a national cohort study. Spine J 2012; 12:492-9. [PMID: 22703754 DOI: 10.1016/j.spinee.2012.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/03/2011] [Accepted: 05/17/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative stroke is a rare complication of spinal fusion surgery, but its relevant risk and incidence remain unclear. PURPOSE To investigate the incidence and risk of stroke after spinal fusion surgery. STUDY DESIGN Cohort study. PATIENT SAMPLE All study subjects were extracted from a nationwide representative cohort of one million people from 2000 to 2005. OUTCOME MEASURES Stroke, including hemorrhagic and ischemic, during the study period. METHODS An exposure group of 2,249 subjects who received spinal fusion surgery during the study period was compared with 2,203 control subjects matched by age, sex, and propensity score. All were followed up for 3 years for all kinds of stroke. Demographics, comorbidities, and nonmeasurable covariates were matched between the two groups. Kaplan-Meier analyses were performed, with adjustments by Cox regression model. RESULTS There were 4,452 subjects, including 2,249 spinal fusion patients and 2,203 controls, who were followed up for 12,967 person-years. The incidence rates of any, hemorrhagic, and ischemic strokes were 9.95, 1.21, and 8.86, respectively, per 1,000 person-years in the spinal fusion group and 11.5, 1.69, and 9.93, respectively, in the comparison group. Patients who received spinal fusion surgery were less likely to have any stroke (crude hazard ratio [HR]=0.87, p=.393), hemorrhagic stroke (HR=0.72, p=.473), and ischemic stroke (HR=0.89, p=.582) than the comparison group but without statistical significance. After adjusting for demographics, comorbidities, and medications, there were still no significant differences for risks of any, hemorrhagic, and ischemic strokes (adjusted HR=0.89, 1.36, and 0.87; p=.522, .553, and .477, respectively) in the spinal fusion group. CONCLUSIONS Patients receiving spinal fusion surgery have similar incidence rates of having a stroke within 3 years postoperation as those without surgery. Risks of any postoperative stroke are similar or insignificantly lower in the spinal fusion group.
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Affiliation(s)
- Jau-Ching Wu
- Institute of Pharmacology, National Yang-Ming University, 2F, No. 322, Shih-Pai Rd, Sec. 2, Peitou, Taipei 11217, Taiwan
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You SH, Son KR, Lee NJ, Suh JK. Remote cerebral and cerebellar hemorrhage after massive cerebrospinal fluid leakage. J Korean Neurosurg Soc 2012; 51:240-3. [PMID: 22737308 PMCID: PMC3377885 DOI: 10.3340/jkns.2012.51.4.240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/16/2012] [Accepted: 04/17/2012] [Indexed: 11/27/2022] Open
Abstract
Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.
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Affiliation(s)
- Sung-Hye You
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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Hempelmann RG, Mater E. Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 4:S564-8. [PMID: 22526701 DOI: 10.1007/s00586-012-2302-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 03/03/2012] [Accepted: 04/02/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intracranial haemorrhage is a rare complication of spinal surgery. Three cases of cerebral or cerebellar haemorrhages following spinal operations with CSF loss are reported, and the literature was reviewed. CASE PRESENTATIONS One patient suffered from melancholy after the operation, one patient had moderate headache and nausea, and the third patient suffered from mental confusion and anxiety. The intracranial haemorrhages were treated conservatively. All patients recovered from the bleedings. RESULTS The cases show that cerebral or cerebellar haemorrhage after spinal CSF loss may be accompanied by minor or rather untypical clinical symptoms. CONCLUSION The dangerous complication of intracranial haemorrhage has to be kept in mind when patients have moderate cerebral symptoms after CSF loss due to spinal operations.
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Affiliation(s)
- Ralf G Hempelmann
- Department of Neurosurgery and Spine Surgery, ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany.
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Dincer A, Özcan Ü, Kaya D, Usseli Mİ, Erzen C, Pamir MN. Asymptomatic Remote Cerebellar Hemorrhage: CT and MRI Findings. THE CEREBELLUM 2012; 11:880-6. [DOI: 10.1007/s12311-011-0351-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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