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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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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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3
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Sturiale CL, Rossetto M, Ermani M, Volpin F, Baro V, Milanese L, Denaro L, d'Avella D. Remote cerebellar hemorrhage after supratentorial procedures (part 1): a systematic review. Neurosurg Rev 2016; 39:565-73. [PMID: 26846668 DOI: 10.1007/s10143-015-0691-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/12/2015] [Accepted: 10/31/2015] [Indexed: 12/30/2022]
Abstract
A remote cerebellar hemorrhage (RCH) is a spontaneous bleeding in the posterior fossa, which may rarely occurs as a complication of supratentorial procedures, and it shows a typical bleeding pattern defined "the zebra sign." However, its pathophysiology still remains unknown. We performed a comprehensive review collecting all cases of RCH after supratentorial craniotomies reported in literature in order to identify the most frequently associated procedures and the possible risk factors. We assessed percentages of incidence and 95 % confidence intervals of all demographic, neuroradiological, and clinical features of the patients. Univariate and multivariate analyses were used to evaluate their association with outcome. We included 49 articles reporting 209 patients with a mean age of 49.09 ± 17.07 years and a male/female ratio 130/77. A RCH was more frequently reported as a complication of supratentorial craniotomies for intracranial aneurysms, tumors debulking, and lobectomies. In the majority of cases, RCH occurrence was associated with impairment of consciousness, although some patients remained asymptomatic or showed only slight cerebellar signs. Coagulation disorders, perioperative cerebrospinal fluid drainage, hypertension, and seizures were the most frequently reported risk factors. Zebra sign was the most common bleeding pattern, being observed in about 65 % out of the cases, followed by parenchymal hematoma and mixed hemorrhage in similar percentages. A multivariate analysis showed that symptomatic onset and intake of antiplatelets/anticoagulants within a week from surgery were independent predictors of poor outcome. However, about 75 % out of patients showed a good outcome and a RCH often appeared as a benign and self-limiting condition, which usually did not require surgical treatment, but only prolonged clinical surveillance, unless in the event of the occurrence of complications.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy.
| | - Marta Rossetto
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Mario Ermani
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Francesco Volpin
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Valentina Baro
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Laura Milanese
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Luca Denaro
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
| | - Domenico d'Avella
- Department of Neurosciences, University of Padua (IT), Via Giustiniani 2, 35128, Padua, Italy
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Das KK, Nair P, Mehrotra A, Sardhara J, Sahu RN, Jaiswal AK, Kumar R. Remote cerebellar hemorrhage: Report of 2 cases and review of literature. Asian J Neurosurg 2015; 9:161-4. [PMID: 25685208 PMCID: PMC4323901 DOI: 10.4103/1793-5482.142737] [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] [Indexed: 11/04/2022] Open
Abstract
Remote cerebellar hemorrhage (RCH) is an extremely rare and potentially devastating complication of supratentorial and spinal surgeries. While there are numerous postulates explaining the patho-physiology behind this phenomenon, including the most popular CSF over drainage theory, the exact cause for the same is still largely unknown. In this report, we present 2 cases of remote cerebellar hemorrhage encountered following 2 different surgical procedures. One patient had preceding pterional craniotomy for ruptured anterior communicating artery aneurysm while the other one developed RCH after placement of EVD. Both of them had history of poorly controlled hypertension, contrary to most reports where hypertension has not been found to be commonly associated with it. Moreover, while most cases have been reported to occur following supratentorial craniotomies and spinal surgeries, one of our patients developed the same after placement of the EVD, which, to the best of our knowledge, has not been reported earlier.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Prakash Nair
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R N Sahu
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A K Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Smith R, Kebriaei M, Gard A, Thorell W, Surdell D. Remote cerebellar hemorrhage following supratentorial cerebrovascular surgery. J Clin Neurosci 2013; 21:673-6. [PMID: 24238635 DOI: 10.1016/j.jocn.2013.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/15/2013] [Indexed: 10/26/2022]
Abstract
Three patients with remote cerebellar hemorrhage following supratentorial cerebrovascular surgery are presented. Remote cerebellar hemorrhage is a rare surgical complication that is most often associated with aneurysm clipping or temporal lobectomies. Bleeding occurs on the superior cerebellar cortex and is believed to be venous in origin. The precise pathogenesis of remote cerebellar hemorrhage has yet to be fully elucidated but is generally considered to be a consequence of intraoperative cerebrospinal fluid loss causing caudal displacement of the cerebellum with resultant stretching of the supracerebellar veins. This case series will hopefully shed further light on the incidence, presentation, workup, and treatment of this particular complication of supratentorial surgery.
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Affiliation(s)
- Ross Smith
- Department of Surgery, Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Meysam Kebriaei
- Department of Surgery, Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew Gard
- Department of Surgery, Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - William Thorell
- Department of Surgery, Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel Surdell
- Department of Surgery, Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
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Remote Cerebellar Hemorrhage after Removal of a Supratentorial Glioma without Perioperative CSF Loss: A Case Report. Case Rep Surg 2013; 2013:305039. [PMID: 23533910 PMCID: PMC3600142 DOI: 10.1155/2013/305039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022] Open
Abstract
A 44-year-old man presented with the rare complication of remote cerebellar hemorrhage (RCH) after removal of a supratentorial glioma without the loss of a large volume of cerebrospinal fluid (CSF). He presented with severe headache, nausea, and vomiting for a few days, then he developed neurological deterioration including progressive disturbance of consciousness and left hemiparesis. Magnetic resonance imaging revealed a large tumor with intratumoral hemorrhage in the right frontal lobe that led to subfalcial and transtentorial herniation. The tumor was removed en bloc without excessive loss of CSF throughout the perioperative period. Although the level of consciousness remained unchanged from the preoperative level and no new neurological deficit was detected, routine postoperative computed tomography showed a bilateral RCH. Careful conservative therapy was provided and follow-up computed tomography demonstrated no further progression of hemorrhage. Compensatory acute engorgement of venous sinuses derived from the rapid decrease in intracranial pressure that occurred due to removal of the huge tumor might have caused cerebellar hemorrhagic venous infarction.
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7
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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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Lee HY, Kim SH, So KY. Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report-. Korean J Anesthesiol 2012; 63:270-3. [PMID: 23060987 PMCID: PMC3460159 DOI: 10.4097/kjae.2012.63.3.270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/18/2011] [Accepted: 10/21/2011] [Indexed: 11/24/2022] Open
Abstract
A patient with remote cerebellar hemorrhage (RCH) who was presented at the authors' hospital with seizure and delayed emergence from anesthesia after loss of cerebrospinal fluid (CSF) through a dural tear during lumbar spine surgery is described. RCH is a rare and unpredictable complication after spinal surgery. Its most common clinical features are diminished consciousness, headache, and seizure. Its mechanism is still disputed, but is probably venous bleeding secondary to significant intra- or post-operative loss of CSF. Therefore, RCH must be considered in patients with unexplained mental deterioration or disturbance upon emergence and seizure from general anesthesia after spine surgery.
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Affiliation(s)
- Hyun-Young Lee
- Department of Anesthesiology and Pain Medicine, Chosun University Medical School, Gwangju, Korea
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Huang CY, Lee PH, Lin SH, Chuang MT, Sun YT, Hung YC, Lee EJ. Remote cerebellar hemorrhage following supratentorial craniotomy. Neurol Res 2012; 34:422-9. [PMID: 22664148 DOI: 10.1179/1743132811y.0000000072] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedure. The exact pathophysiology of this type of hemorrhage is poorly understood. We retrospectively compared 16 patients who had remote cerebellar hemorrhage (RCH) with a case-matched control cohort, to determine the significance of perisurgical and surgical factors that may predispose patients to such bleeding events. METHODS From 1 June 2005 to 31 December 2008, postoperative routine head computed tomographic (CT) scan was performed in our institution and 16 patients with RCH after supratentorial neurosurgical procedure were identified. The medical charts of these 16 cases and a control cohort of 64 patients were recorded. All parameters were analyzed with regards to various variables. RESULTS The incidence RCH after supratentorial craniotomy increased after postoperative computed tomographic scan. The mechanism of cerebellar hemorrhage in this series of patients is most likely multifactorial. Several variables showed a significant association with the occurrence of RCH. Multivariate analysis indicated that the following two factors independently correlated with occurrence of RCH: (1) postoperative epidural drainage amount; and (2) history of previous cerebrovascular accident (CVA) with cerebral atrophy. All cases with RCH underwent medical treatment and no neurological sequelae associated with RCH. CONCLUSIONS Postoperative epidural drainage amount and history of previous CVA with cerebral atrophy can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy. One of the most important strategies to minimize hazardous complications is to be aware of these potential risk factors and to take action to prevent them.
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Affiliation(s)
- Chih-Yuan Huang
- National Cheng-Kung University Medical Center and Medical School, Tainan, Taiwan
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10
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Park JS, Hwang JH, Park J, Hamm IS, Park YM. Remote cerebellar hemorrhage complicated after supratentorial surgery: retrospective study with review of articles. J Korean Neurosurg Soc 2009; 46:136-43. [PMID: 19763216 DOI: 10.3340/jkns.2009.46.2.136] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/06/2009] [Accepted: 08/06/2009] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. METHODS We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. RESULTS There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. CONCLUSION RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.
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Affiliation(s)
- Jae-Suk Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
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11
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Huang CY, Hung YC, Lee EJ. Remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery: report of three cases. Neurol Res 2009; 32:670-2. [PMID: 19660199 DOI: 10.1179/174313209x459156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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Huang CY, Hung YC, Tai SH, Lee EJ. Cerebellar Hemorrhage After Multiple Manual Pumping Tests of a Ventriculoperitoneal Shunt: A Case Report. Kaohsiung J Med Sci 2009; 25:29-33. [PMID: 19289315 DOI: 10.1016/s1607-551x(09)70037-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Hashidate H, Kamimura M, Nakagawa H, Takahara K, Uchiyama S, Kato H. Cerebellar hemorrhage after spine surgery. J Orthop Sci 2008; 13:150-4. [PMID: 18392920 DOI: 10.1007/s00776-007-1199-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 10/17/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroyuki Hashidate
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Bernal-García L, Cabezudo-Artero J, Ortega-Martínez M, Fernández-Portales I, Ugarriza-Echebarrieta L, Pineda-Palomo M, Porras-Estrada L, Gómez-Perals L. Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70211-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Tucker A, Miyake H, Tsuji M, Ukita T, Nishihara K. Remote cerebellar hemorrhage after supratentorial unruptured aneurysmal surgery: report of three cases. Neurol Res 2007; 29:493-9. [PMID: 17535556 DOI: 10.1179/016164107x164094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We report three cases of remote cerebellar hemorrhage that developed after supratentorial unruptured aneurysmal surgery. In all cases, digital subtraction angiography was performed before each operation in order to rule out other vascular abnormalities, especially around the operative field or the posterior circulation. In addition, all patients were screened for any previous history of bleeding tendencies or other related medical disorders. Each patient underwent clipping surgery via the pterional approach. Remote cerebellar hemorrhage was identified on post-operative computed tomographic scans. In all cases, there was no evidence of significant associated long-term morbidity. A consideration of the possible pathophysiologic mechanisms underlying these post-operative remote cerebellar hemorrhages and suggested strategies for avoiding such complications are discussed.
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Affiliation(s)
- Adam Tucker
- Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.
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16
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Hsieh CT, Chiang YH, Tsai TH, Chen CY, Su YH. Multiple intracranial hemorrhages after evacuation of bilateral subdural effusions. Neuroradiol J 2007; 20:190-3. [PMID: 24299642 DOI: 10.1177/197140090702000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/25/2007] [Indexed: 11/16/2022] Open
Abstract
Postoperative intracerebral hemorrhages occurring after evacuation of subdural fluid collections have been infrequently reported and remain a devastating complication. The pathophysiological mechanism is still unclear. Disturbed autoregulation and restoration of normal cerebral flow seems to play an important role in this type of event because of rapid decompression. Herein, we present a case of multiple intracerebral hemorrhages in the putamen and cerebellar hemisphere following evacuation of bilateral subdural effusions, and review the relevant literature.
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Affiliation(s)
- Cheng-Ta Hsieh
- Department of Neurological Surgery; Tri-Service General Hospital, National Defense Medical Center; Taipei, Taiwan, Republic of China -
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17
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González-Robledo J, González-Pérez G, Diego-Calvo A, Díaz-Martín O. [Cerebellar hemorrhaging after excision of a pituitary tumor by supratentorial craniotomy]. Med Intensiva 2006; 30:298-9. [PMID: 16949007 DOI: 10.1016/s0210-5691(06)74529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. Multiple cerebellar hemorrhagic infarctions following surgery for a huge atlantoaxial neurinoma. Spine J 2006; 6:86-9. [PMID: 16413453 DOI: 10.1016/j.spinee.2005.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 02/03/2005] [Accepted: 04/13/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There have been only five reported cases with cerebellar hemorrhagic infarction after spinal surgery, and the underlying pathomechanism remains obscure. PURPOSE To describe a case with multiple cerebellar hemorrhagic infarctions after surgery for a huge atlantoaxial neurinoma. STUDY DESIGN/SETTING Case report METHODS A 36-year-old man underwent uneventful surgery for a huge atlantoaxial neurinoma. After surgery, the patient was lethargic with slurred speech and subsequently developed cerebellar symptoms, although preoperative myelopathic symptoms did not worsen. The clinical and radiological findings are presented, and possible causes of the hemorrhages are discussed. RESULTS Magnetic resonance imaging of the brain after surgery showed multiple cerebellar hemorrhagic infarctions. However, magnetic resonance angiography revealed no occlusion or stenosis in the vertebrobasilar system, and a duplex scan of the neck vessels confirmed normal flow in the vertebral arteries after surgery. In response to the conservative treatment, the patient exhibited neurological recovery with disappearance of cerebellar symptoms. CONCLUSIONS In the present case with multiple cerebellar hemorrhagic infarctions, venous infarction appears more likely to be the cause of cerebellar hemorrhagic infarction than arterial infarction. The most likely underlying pathomechanism is a cerebellar venous disturbance precipitated by loss of a large amount of cerebrospinal fluid, although the exact etiology remains elusive.
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Affiliation(s)
- Hironobu Sakaura
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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