1
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Scalia G, Silven MP, Costanzo R, Chaurasia B, Furnari M, Iacopino DG, Nicoletti GF, Umana GE. Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report. Clin Case Rep 2023; 11:e8271. [PMID: 38033701 PMCID: PMC10682235 DOI: 10.1002/ccr3.8271] [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: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
Remote intracerebral hemorrhage (RICH) is a rare yet highly consequential complication that can occur after a craniotomy performed for the evacuation of an intracerebral hemorrhage (ICH). In this case report, we present the clinical details of a 74-year-old female patient who underwent a supratentorial craniotomy to address an ICH, and subsequently developed RICH. A 74-year-old woman was admitted to our department with a severe headache, onset of dysarthria, and left-sided brachio-crural hemiparesis. The patient had a history of arterial hypertension and a previous cerebral ischemia incident 2 years prior, potentially due to cerebral amyloid angiopathy. Despite the immediate surgical intervention and intensive care, she succumbed to respiratory distress after developing a contralateral ICH. RICH following craniotomy for an intracerebral hematoma is a rare but potentially devastating complication. Close monitoring, prompt recognition of neurological deterioration, and timely intervention are imperative to optimize patient outcomes. Further research is needed to better understand the underlying mechanisms and risk factors associated with this complication, allowing for improved prevention and management strategies in the future.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryARNAS GaribaldiCataniaItaly
| | - Manikon Poullay Silven
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical ClinicAzienda Ospedaliera Universitaria Policlinico (AOUP) “Paolo Giaccone”PalermoItaly
| | - Roberta Costanzo
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical ClinicAzienda Ospedaliera Universitaria Policlinico (AOUP) “Paolo Giaccone”PalermoItaly
| | | | - Massimo Furnari
- Neurosurgery Unit, Department of Head and Neck SurgeryARNAS GaribaldiCataniaItaly
| | - Domenico Gerardo Iacopino
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical ClinicAzienda Ospedaliera Universitaria Policlinico (AOUP) “Paolo Giaccone”PalermoItaly
- Neurosurgery ClinicBirgunjNepal
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2
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Okal FM, Hamzah A, Mahboob H, Alrebai R. Remote Cerebellar Hematoma Following Supratentorial Craniotomy: A Case Report. Cureus 2023; 15:e39647. [PMID: 37388599 PMCID: PMC10306318 DOI: 10.7759/cureus.39647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Remote cerebellar hemorrhage (RCH) is a rare complication following supratentorial craniotomies with unclear pathophysiology, predisposing factors, and clinical outcomes. This is a case of a 46-year-old female who presented to the emergency room with a complaint of severe headache associated with nausea. MRI studies demonstrated right frontal lesions consistent with low-grade glioma. She underwent a right frontal craniotomy, and the tumor was resected successfully. She developed a severe headache on postoperative day five, and CT scans showed ipsilateral cerebellar hematoma. She was managed conservatively and made a complete recovery within five days. Although rare, RCH requires prompt recognition, neurological monitoring, and management. Medical management and observation may be considered for patients without mass effect or acute hydrocephalus.
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Affiliation(s)
- Fahad M Okal
- Neurosurgery Section, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Abdulaziz Hamzah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hani Mahboob
- Department of Neurosurgery, King Fahad General Hospital, Jeddah, SAU
| | - Riyadh Alrebai
- Department of Neurosurgery, King Fahad General Hospital, Jeddah, SAU
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3
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Yoshida K, Toda M, Yamada Y, Yamada M, Yokoyama Y, Tsutsumi K, Fujiwara H, Kosugi K, Jinzaki M. Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography. Sci Rep 2022; 12:10482. [PMID: 35729166 PMCID: PMC9213471 DOI: 10.1038/s41598-022-13276-0] [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: 09/27/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.,Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kei Tsutsumi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
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4
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Remote cerebral and cerebellar hemorrhage after removal of supratentorial Ganglioglioma: A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Wen P, Xu W, Chen H. Intracranial hemorrhage following drainage of chronic subdural effusion and hematoma: A case report and review of the literature. IBRAIN 2022; 8:68-77. [PMID: 37786413 PMCID: PMC10528771 DOI: 10.1002/ibra.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 10/04/2023]
Abstract
Acute intracranial hemorrhage (AIH) after drainage of chronic subdural hematoma is a rare but serious complication. An 86-year-old man with bilateral frontotemporal subdural effusion, hematoma, and cerebral hernia was admitted to our department and treated with bilateral burr hole surgery and closed-system drainage under local anesthesia. After the operation, computed tomography (CT) showed AIH in the left temporal and occipital lobe, and then a series of head CT showed that the hematoma gradually increased day by day. This patient had a medical history of hypertension, diabetes, atrial fibrillation, and taking warfarin. He was treated conservatively, but had not recovered at discharge after 1 month. We reviewed the relevant literature and analyzed the operation opportunity, causes of cerebral hemorrhage, and preventive measures in similar patients. We suppose that the coagulation abnormality and rapid fluctuations of intracranial pressure were the main causes of development of AIH in our patient. Several possible reasons such as brain shift and impaired vascular autoregulation are also associated with postoperative AIH. We must be aware of this complication and keep some preventive measures in our mind.
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Affiliation(s)
- Peng Wen
- Department of NeurosurgeryXuanwu Hospital Capital Medical UniversityBeijingChina
- Department of NeurosurgeryThe First People's Hospital of ZunyiZunyiGuizhouChina
| | - Wen‐Long Xu
- Department of NeurosurgeryXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Huan Chen
- Clinical Pharmacy DepartmentThe First People's Hospital of ZunyiZunyiGuizhouChina
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6
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Jang TH, Paeng SH, Shim YW, Lee WH, Kim ST, Lee KS. Delayed Multiple Intracerebral Hemorrhage After Burr Hole Drainage of Chronic Subdural Hematoma During Failure of Warfarin Resumption in Atrial Fibrillation. Korean J Neurotrauma 2022; 18:83-88. [PMID: 35557631 PMCID: PMC9064741 DOI: 10.13004/kjnt.2022.18.e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/26/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tae Hoon Jang
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yong woo Shim
- Department of Neurosurgery, Gyungnam Military Manpower Administration, Changwon, Korea
| | - Won Hee Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung-Tae Kim
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Keun Soo Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
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7
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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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8
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Lafta GA, Dolachee AA. Supratentorial intracerebral hemorrhage as a complication of infratentorial tumor removal: A case report. Int J Surg Case Rep 2020; 75:1-3. [PMID: 32896680 PMCID: PMC7481883 DOI: 10.1016/j.ijscr.2020.08.031] [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: 07/16/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Intracerebral hemorrhage (ICH) at the operative site is one of the major complications of brain surgery. Imaging modalities like CT scan can easily discover and diagnose intracerebral hemorrhage. When intracerebral hemorrhage occurs it may lead to deadly complications and best to be surgically evacuated. Supratentorial intracerebral hemorrhage rarely complicates surgeries of infratentorial tumors.
Introduction In this article we report a case of supratentorial intracerebral hemorrhage developed following days of posterior fossa surgical tumor removal. Presentation of case Nine years old female was diagnosed as a patient with posterior fossa tumor and hydrocephalus, endoscopic third ventriculostomy was done and the tumor was resected using craniectomy and trans-vermian approach. The patient was discharged home on post-operative day 10 but re-admitted on day 35 with a new insult of right temporo-parieto-occipital intracerebral hematoma which was evacuated successfully urgently and the patient had got better on day 4, but then she developed right hemispheric ischemia and died. Discussion Although this complication is rare, it carries significant morbidity and mortality, literatures discussing this condition are scanty and no obvious cause was mentioned. Conclusion We recommend putting in mind such a complication in case of any post-operative neurological deterioration occurs to a patient with surgically excised posterior fossa lesion.
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Affiliation(s)
- Ghazwan A Lafta
- Department of Surgery, Faculty of Medicine, University of Al-Ameed, Karbala, Iraq.
| | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq.
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9
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Lee I, Park CW, You CJ, Choi DH, Park K, Kim YB, Kim WK, Yee GT, Kim MJ, Kim EY. Risk factors of postoperative remote intracerebral hemorrhage after craniotomy for ruptured cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2020; 22:53-64. [PMID: 32665912 PMCID: PMC7329564 DOI: 10.7461/jcen.2020.22.2.53] [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: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022] Open
Abstract
Objective We aimed to identify the relation between perioperative cerebrospinal fluid (CSF) drain through lumbar drainage (LD) and development of postoperative (POP) remote intracerebral hemorrhage (rICH) in craniotomy to treat ruptured intracranial aneurysms. Methods We retrospectively reviewed consecutive patients who underwent craniotomy for ruptured cerebral aneurysms at the authors’ institution between 1998 and 2004. We subsequently compared the incidence and characteristics of POP rICH between the patients who had a perioperative LD and those who did not. All statistical analyses were conducted using the software package SPSS 19.0 (SPSS Inc., Chicago, IL, USA). A p value of <0.05 was considered statistically significant. Results We enrolled 688 patients, of which 80 patients (11.6%) received perioperative LD, and 608 did not. LD and non-LD groups were comparable because although clinical characteristics of the two groups were significantly different considering history of hypertension, timing of surgery, and closed system negative pressure suction drain (SD) placement, none of these three variables was an independent risk factor associated with POP rICH in multivariate analysis. POP rICH incidence was significantly higher in the LD goup (12.5%) than non-LD group (0.8%) (p=0.000) in univariate analysis. LD placement was the only independent risk factor associated with the development of rICH in multivariate logistic regression analysis. Conclusions POP rICH incidence was significantly higher in patients who were managed with perioperative LD than in those who did not. LD insertion in craniotomy for ruptured intracranial aneurysm, should be closely monitored to address the occurrence of POP rICH.
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Affiliation(s)
- Insu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Chan Jong You
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kwangwoo Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Young Bo Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gi-Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Myeong-Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
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10
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Multiple Remote Sequential Supratentorial Epidural Hematomas-An Unusual and Rare Complication After Posterior Fossa Surgery. World Neurosurg 2019; 128:83-90. [PMID: 31071445 DOI: 10.1016/j.wneu.2019.04.228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postoperative hemorrhage is a serious complication of intracranial surgery. Epidural hematomas (EDHs) are one of the common forms of bleeding after surgery, with ≤12% of patients requiring re-exploration. However, distant or remote site EDHs have been rare, in particular, those in a supratentorial location after infratentorial surgery. CASE DESCRIPTION We report an unusual complication of surgery for fourth ventricular outlet obstruction. A young male patient developed multiple sequential supratentorial EDHs after posterior fossa surgery. He required 2 re-explorations after the primary surgery for evacuation of the EDHs within 24 hours. In the available data, we found only 28 such reported cases previously. Only 2 additional cases have been reported to have sequential EDHs after surgery. Various theories have been postulated, ranging from sudden intracranial pressure decompression, pin site hematoma, and shunt site bleeding due to dural stripping. None has been proven to definitively explain the complication. CONCLUSIONS We wished to highlight this unusual complication of posterior fossa surgery, with an emphasis on rapid computed tomography scanning of the brain for patients in the early postoperative period with any neurological deterioration. Early radiological detection and timely intervention can be lifesaving.
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11
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Numaguchi D, Wada K, Yui M, Tamaki R, Okazaki K. Incidence of Remote Cerebellar Hemorrhage in Patients with a Dural Tear during Spinal Surgery: A Retrospective Observational Analysis. Spine Surg Relat Res 2018; 3:141-145. [PMID: 31435566 PMCID: PMC6690084 DOI: 10.22603/ssrr.2018-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction The incidence of remote cerebellar hemorrhage (RCH) in patients with a dural tear during spinal surgery is unclear. The purpose of this study was to determine the incidence of RCH and the causative factors in these patients. Methods Two hundred and thirty-nine patients underwent spinal surgery at our institution between March 2015 and September 2016. Eleven of these patients needed dural suturing intraoperatively. All patients underwent CT of the head on the first postoperative day and were categorized according to whether they had RCH or not. The mean values for the amount of intraoperative bleeding, maximum perioperative blood pressure, postoperative drainage volume, and complaints of headache during the first 24 h postoperatively were compared between the two groups using the Welch's two-sample t-test and Fisher's exact test. The follow-up duration was 12 months. Results There were four patients in the RCH group and seven in the non-RCH group. The incidence of RCH was 36.4%. There were three cerebellar hemorrhages and one interhemispheric fissure hemorrhage in the RCH group. The mean intraoperative bleeding volume was 284 mL in the RCH group and 569 mL in the non-RCH group. The mean respective values for maximum perioperative blood pressure and postoperative drainage volume were 132 mmHg and 547 mL in the RCH group and 144 mmHg and 567 mL in the non-RCH group; none of the differences was statistically significant. However, complaints of headache in the first 24 h postoperatively were significantly more common in the RCH group than in the non-RCH group (100% vs. 14.3%; p = 0.01). All patients with intracranial bleeding had recovered 3 months after surgery. Conclusions The incidence of RCH following a dural tear during spinal surgery was 36.4%. There was a significant association between RCH and increased reporting of headache during the first 24 h postoperatively.
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Affiliation(s)
- Daisuke Numaguchi
- Department of Orthopedics Surgery, Tomei Atsugi Hospital, Kanagawa, Japan
| | - Keiji Wada
- Department of Orthopedics Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Yui
- Department of Orthopedics Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Tamaki
- Department of Orthopedics Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedics Surgery, Tokyo Women's Medical University, Tokyo, Japan
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12
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Senders JT, Muskens IS, Cote DJ, Goldhaber NH, Dawood HY, Gormley WB, Broekman MLD, Smith TR. Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors: A National Surgical Quality Improvement Program Analysis. Neurosurgery 2018; 83:1249-1259. [DOI: 10.1093/neuros/nyy001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Joeky T Senders
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo S Muskens
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David J Cote
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole H Goldhaber
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hassan Y Dawood
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William B Gormley
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Karaarslan N, Gürbüz MS, Caliskan T, Tunckale T. Remote Cerebellar Haemorrhage Occurring after Transcranial Pituitary Surgery. J Clin Diagn Res 2017; 11:PD15-PD16. [PMID: 28969203 DOI: 10.7860/jcdr/2017/29152.10465] [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: 04/07/2017] [Accepted: 06/17/2017] [Indexed: 11/24/2022]
Abstract
Post supratentorial and spinal surgeries, in rare cases, Remote Cerebellar Haemorrhage (RCH) develops as a complication. Although the exact aetiology of RCH remains uncertain, excessive drainage of the Cerebrospinal Fluid (CSF) is accepted as the most possible cause. It has been suggested that overdrainage of CSF leads to stretching and resultantly tearing of the cerebellar veins. Early diagnosis and appropriate management decrease mortality and morbidity significantly. In this report, we present a case of RCH encountered on the third postoperative day of transcranial pituitary surgery and discuss the possible causative factors. Excessive loss of CSF is considered to be the major cause of RCH. To our knowledge this is the first case of RCH seen after transcranial macroadenoma surgery reported in the literature so far.
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Affiliation(s)
- Numan Karaarslan
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
| | - Mehmet Sabri Gürbüz
- Specialist Neurosurgeon, Department of Neurosurgery, Elaziğ Training and Research Hospital, Elaziğ, Turkey
| | - Tezcan Caliskan
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
| | - Tamer Tunckale
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
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14
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Tabibkhooei A, Taheri M, Fattahi A, Ebrahimniya F, Benam M. Remote cerebellar hemorrhage: Report of two different cases. Surg Neurol Int 2017; 8:54. [PMID: 28540120 PMCID: PMC5421363 DOI: 10.4103/sni.sni_20_17] [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] [Received: 01/11/2017] [Accepted: 01/28/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Remote cerebellar hemorrhage (RCH) is a rare complication after supratentorial craniotomies, which usually presents as linear hemorrhages on the surface of the cerebellum; the exact mechanism of it is not established yet. CASE DESCRIPTION In case one, a 57-year-old patient demonstrated hemorrhage in the cerebellar sulci in favor of RCH 2 days after craniotomy for sphenoidal wing meningioma resection. He was asymptomatic and showed good prognosis after conservative treatment. However, in the second case, a 21-year-old man presented with symptomatic RCH just after the surgery for resection of huge intraaxial parietooccipital lesion. He had a poor prognosis despite the treatment and died ultimately. CONCLUSION Although some studies reported the good prognosis for this type of hemorrhage, it can cause neurological and clinical deterioration and result to patient death.
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Affiliation(s)
| | - Morteza Taheri
- Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | | | | | - Mohsen Benam
- Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
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15
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Patibandla MR, Thotakura AK, Shukla D, Purohit AK, Addagada GC, Nukavarapu M. Postoperative hematoma involving brainstem, peduncles, cerebellum, deep subcortical white matter, cerebral hemispheres following chronic subdural hematoma evacuation. Asian J Neurosurg 2017; 12:259-262. [PMID: 28484546 PMCID: PMC5409382 DOI: 10.4103/1793-5482.144163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Among the intracranial hematomas, chronic subdural hematomas (CSDH) are the most benign with a mortality rate of 0.5-4.0%. The elderly and alcoholics are commonly affected by CSDH. Even though high percentage of CSDH patients improves after the evacuation, there are some unexpected potential complications altering the postoperative course with neurological deterioration. Poor outcome in postoperative period is due to complications like failure of brain to re-expand, recurrence of hematoma and tension pneumocephalus. We present a case report with multiple intraparenchymal hemorrhages in various locations like brainstem, cerebral and cerebellar peduncles, right cerebellar hemisphere, right thalamus, right capsulo-ganglionic region, right corona radiata and cerebral hemispheres after CSDH evacuation. Awareness of this potential problem and the immediate use of imaging if the patient does not awake from anesthesia or if he develops new onset focal neurological deficits, are the most important concerns to the early diagnosis of this rare complication.
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Affiliation(s)
- Mohana Rao Patibandla
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Dinesh Shukla
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anirudh K Purohit
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gokul Chowdary Addagada
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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16
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Contralateral development of acute subdural hematoma (SDH) immediately following a burr-hole craniostomy for chronic SDH. INTERDISCIPLINARY NEUROSURGERY 2016. [DOI: 10.1016/j.inat.2016.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Barami K. Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion. Neurosurg Focus 2016; 41:E9. [DOI: 10.3171/2016.6.focus16172] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.
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18
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Prasad GL. Remote site hemorrhage after intracranial surgeries: is it really benign? Br J Neurosurg 2016; 30:689-690. [DOI: 10.1080/02688697.2016.1220507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Himes BT, Mallory GW, Abcejo AS, Pasternak J, Atkinson JLD, Meyer FB, Marsh WR, Link MJ, Clarke MJ, Perkins W, Van Gompel JJ. Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg 2016; 127:182-188. [PMID: 27494821 DOI: 10.3171/2016.5.jns152328] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Historically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series. METHODS The authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure. RESULTS In a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2-70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12-0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of complications in intradural cases was significantly higher (OR 7.3, 95% CI 1.4-39, p = 0.02) than for extradural cases. The risk of VAE in intradural spine procedures did not differ significantly from sitting suboccipital craniotomy/craniectomy cases (OR 0.69, 95% CI 0.09-5.4, p = 0.7). Two cases (0.1%) had to be aborted intraoperatively due to complications. There were no instances of intraoperative deaths, although there was a single death within 30 days of surgery. CONCLUSIONS In this large, modern series of cases performed in the sitting position, the complication rate was low. Suboccipital craniotomy/craniectomy was associated with the highest risk of complications. When appropriately used with modern anesthesia techniques, the sitting position provides a safe means of surgical access.
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20
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The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion. Childs Nerv Syst 2016; 32:599-607. [PMID: 26767844 DOI: 10.1007/s00381-015-3010-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
Loss of cerebrospinal fluid (CSF) occurs commonly in daily neurosurgical practice. Understanding the altered physiology following CSF loss is important for optimization of patient care and avoidance of complications. There is overwhelming evidence now that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. The CSF and cerebral venous compartments are tightly coupled in two important ways. CSF is resorbed into the venous system, and there is also an evolved mechanism that prevents overdrainage of venous blood with upright positioning known as the Starling resistor. With loss of CSF pressure, this protective mechanism could become nonfunctional which may result in posture-related venous overdrainage through the cranial venous outflow tracts leading to pathologic states. This review article summarizes the relevant anatomic and physiologic basis of the relationship between the craniospinal venous and CSF compartments in the setting of CSF diversion. It is hoped that this article improves our understanding of ICP dynamics after CSF loss, adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.
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21
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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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22
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Nagasaki H, Yamakawa K, Mochizuki Y, Nakamura Y, Tokunaga H, Yoshida Y, Doi H. Remote Supratentorial Hemorrhage following Supratentorial Craniotomy: A Case Report. NMC Case Rep J 2015; 3:13-16. [PMID: 28663989 PMCID: PMC5386155 DOI: 10.2176/nmccrj.cr.2015-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/24/2015] [Indexed: 11/20/2022] Open
Abstract
Intracranial hemorrhage (ICH) in regions remote from the initial intracranial operation site is rare. The mechanism of ICH following cranial surgery remains unclear, although several theories have been proposed. Most of the reports describe cerebellar hemorrhages after supratentorial procedures or supratentorial hemorrhages after infratentorial procedures. Remote supratentorial hemorrhage (RSH) following supratentorial surgery is extremely rare. We report a case of postoperative RSH occurring away from the surgical site. A 62-year-old woman underwent a right occipital lobectomy to resect lung carcinoma metastases. The patient developed a postoperative consciousness disturbance, and a brain computed tomography (CT) scan revealed an ICH in the left frontal region. The patient underwent ICH evacuation, but remained severely disabled. It is necessary to be aware that this complication is possible after craniotomy.
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Affiliation(s)
- Hirokazu Nagasaki
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Kota Yamakawa
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Yubuhito Mochizuki
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Yoshinori Nakamura
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Hitoshi Tokunaga
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Yoichi Yoshida
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
| | - Hiroshi Doi
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo
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23
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Shimi A, Elbakouri N, Bechri B, Derkaoui A, Agouri M, Khatouf M. [Delayed cerebellar hemorrhage after burr hole drainage of a chronic subdural hematoma]. Pan Afr Med J 2015; 20:421. [PMID: 26309454 PMCID: PMC4537899 DOI: 10.11604/pamj.2015.20.421.6365] [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: 02/18/2015] [Accepted: 04/22/2015] [Indexed: 12/02/2022] Open
Abstract
L'hémorragie cérébelleuse à distance du site de la chirurgie ou remote cerebellar hemorrhage constitue une complication rare de la chirurgie intracranienne. la survenue d'une hémorragie cérébelleuse a distance dans les suites d'un drainage d'un hématome sous dural par trou de trépan reste un événement très rare. Nous rapportons le cas d'un patient ayant présenté ce syndrome après drainage d'un hématome sous dural chronique par trou de trépan avec évolution défavorable. Nous discutons à travers cette observation, les aspects diagnostics et étiopathogéniques de cette complication.
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Affiliation(s)
- Abdelkarim Shimi
- Service de Réanimation Polyvalente A1, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Nabil Elbakouri
- Service de Réanimation Polyvalente A1, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Brahim Bechri
- Service de Réanimation Polyvalente A1, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Ali Derkaoui
- Service de Réanimation Polyvalente A1, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Mohamed Agouri
- Service de Neurochirurgie, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Mohammed Khatouf
- Service de Réanimation Polyvalente A1, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
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24
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de Albuquerque LAF, Dourado JC, Almeida JP, Costa BS. Multiple supratentorial intraparenchymal hemorrhage after posterior fossa surgery. Surg Neurol Int 2015; 6:S104-9. [PMID: 25883853 PMCID: PMC4392548 DOI: 10.4103/2152-7806.153649] [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: 09/02/2014] [Accepted: 12/03/2014] [Indexed: 01/05/2023] Open
Abstract
Background: The intraparenchymal supratentorial hemorrhages after interventions of the posterior fossa is a very rare complication, with very little literature and its precise incidence is unknown (range of 0.4–1.6%). It possesses potentially an etiology diverse from that associated with other postoperative bleeding. Case Description: A white, 23-year-old female, with no history of coagulation disorders or other diseases, was referred to our hospital with a large ependymoma, which extended from the floor of the fourth ventricle, emerged from the foramen of Magendie and descended to the C2 level. The patient was submitted to surgical treatment and during resection of the lesion, when near the vagal trigone, the patient presented great pressure lability. In the immediate postoperative period, the patient did not have a level of consciousness sufficient to tolerate extubation. Brain computed tomography (CT) was carried out, which showed multiple supratentorial hemorrhages. On the ninth day of the postoperative period, there was a sudden neurological worsening and anisocoria. A new brain CT was carried out [Figure 4], which demonstrated a diffuse cerebral edema. In spite of the introduction of clinical measures for the control of diffuse cerebral edema, the patient evolved to brain death. Conclusions: The principal measures in the management of these cases include early diagnosis, detection of possible coagulation disorders, continual monitoring, and maintenance of adequate cerebral perfusion. Surgical treatment is recommended in cases of the presence of mass effect or diffuse edema not yielding to clinical treatment. High rates of mortality and morbidity are observed.
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Affiliation(s)
| | | | - João Paulo Almeida
- Department of Neurology and Neurosurgery, State University of Campinas, Campinas, São Paulo, Brazil
| | - Bruno Silva Costa
- Department of Neurosurgery, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
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25
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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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26
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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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27
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Kamata K, Maruyama T, Nitta M, Ozaki M, Muragaki Y, Okada Y. A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy. J Surg Case Rep 2014; 2014:rju098. [PMID: 25301378 PMCID: PMC4190473 DOI: 10.1093/jscr/rju098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We are reporting the case of a 56-year-old woman who developed loss of consciousness during awake craniotomy. A thin subdural haematoma in the contralateral side of the craniotomy was identified with intraoperative magnetic resonance imaging and subsequently removed. Our case indicates that contralateral acute subdural haematoma could be a cause of deterioration of the conscious level during awake craniotomy.
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Affiliation(s)
- Kotoe Kamata
- Department of Anaesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Makoto Ozaki
- Department of Anaesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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28
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Castelnovo G, Ratiu D, Taieb G. [Remote cerebellar hemorrhage following spinal surgery]. Rev Neurol (Paris) 2014; 170:467-8. [PMID: 24679483 DOI: 10.1016/j.neurol.2014.01.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/01/2014] [Accepted: 01/04/2014] [Indexed: 11/19/2022]
Affiliation(s)
- G Castelnovo
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France.
| | - D Ratiu
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - G Taieb
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France
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29
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Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R. Contralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo) 2014; 53:221-4. [PMID: 23615411 DOI: 10.2176/nmc.53.221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. Burr-hole craniotomy was performed before decompressive craniectomy, and the bleeding source was a cortex artery within the frontal lobe contusion. Despite supportive therapy with barbiturate and mild hypothermia he expired 3 days later of brain death. Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.
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Affiliation(s)
- Jian Shen
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang Province, PRC
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30
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Cohen JE, Rajz G, Itshayek E, Umansky F. Bilateral acute epidural hematoma after evacuation of acute subdural hematoma: brain shift and the dynamics of extraaxial collections. Neurol Res 2013; 26:763-6. [PMID: 15494119 DOI: 10.1179/016164104225015930] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Acute epidural hematoma following supratentorial decompressive craniectomy is a very seldom described but serious complication. The occurrence of intraoperative brain swelling may suggest the development of a contralateral hematoma. A unique case of bilateral acute epidural following decompressive craniectomy and evacuation of acute subdural hematoma is presented. Awareness of unexplained elevation of intracranial pressure is of paramount importance when routine immediate postoperative computed tomography is not performed. This case provides insight into the well-known but poorly understood dynamic process of brain shift and extraaxial collections.
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MESH Headings
- Aged
- Decompression, Surgical/adverse effects
- Female
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/surgery
- Humans
- Intraoperative Complications
- Outcome Assessment, Health Care
- Tomography, X-Ray Computed
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Endovascular Neurosurgery and Interventional Neuroradiology, Hadassah University Hospital, Jerusalem, Israel.
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31
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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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32
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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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33
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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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Agrawal A, Kakani A, Ray K. Extensive supratentorial hemorrhages following posterior fossa meningioma surgery. J Surg Tech Case Rep 2011; 2:87-9. [PMID: 22091344 PMCID: PMC3214287 DOI: 10.4103/2006-8808.73624] [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: 11/23/2022] Open
Abstract
Remote supratentorial hematoma soon after posterior fossa surgery for the removal of a space-occupying lesion is a rare but dramatic and dreaded complication, carrying significant morbidity and mortality. A 47-year-old woman presented with headache of 1-year duration that worsened over last 2 months, progressive ataxia of 2 months’ duration, blurring and diminution of vision of 2 months’ duration and forgetfulness of 2 months’ duration. Fundus showed bilateral papille dema, and visual acuity was 6/9 in both eyes. She had left-sided cerebellar signs. There were no focal motor or sensory neurological deficits. MRI brain with contrast showed a large posterior fossa tumor with obstructive hydrocephalus. The patient underwent left paramedian suboccipital craniectomy in prone position with left side up. In the immediate postoperative period, the patient did no recover from anesthesia and was persistently drowsy. Immediate repeat CT scan showed diffuse subarachnoid hemorrhage spread all over the bilateral cerebral hemispheres with diffuse cerebral edema. The patient recovered with conservative management without deficits. This case stresses the importance of early postoperative CT scan and optimal management of the hemorrhage for good outcome.
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Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
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Vrettou CS, Stavrinou LC, Halikias S, Kyriakopoulou M, Kollias S, Stranjalis G, Koutsoukou A. Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery. Acta Neurochir (Wien) 2010; 152:529-32. [PMID: 19557304 DOI: 10.1007/s00701-009-0432-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 06/01/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative intracranial haemorrhage can be a dramatic event, carrying significant morbidity and mortality. Bleeding at sites remote from the operation area represents a small percentage of haemorrhages whose aetiology remains unclear (Harders et al. Acta Neurochir (Wien) 74(1-2):57-60, 1985). AIM We present the case of a 60-year-old patient who underwent posterior fossa craniotomy for the removal of a space-occupying lesion and suffered supratentorial haemorrhage soon after the operation. RESULTS A thorough postoperative investigation revealed low levels of factor XIII (FXIII), the factor mainly responsible for fibrin clot stabilisation. CONCLUSION We suggest that reduced FXIII activity may be an important but preventable predisposing factor to remote postoperative haemorrhage in neurosurgical patients.
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Affiliation(s)
- Charikleia Spyridon Vrettou
- Critical Care Department and Pulmonary Services, Evangelismos General Hospital, University of Athens Medical School, Athens GR-10675, Greece.
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Chang SH, Yang SH, Son BC, Lee SW. Cerebellar hemorrhage after burr hole drainage of supratentorial chronic subdural hematoma. J Korean Neurosurg Soc 2009; 46:592-5. [PMID: 20062580 DOI: 10.3340/jkns.2009.46.6.592] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 03/05/2009] [Accepted: 10/22/2009] [Indexed: 11/27/2022] Open
Abstract
Cerebellar hemorrhage is an unusual complication of supratentorial neurosurgery. To the best of our knowledge, only three case reports have described the occurrence of cerebellar hemorrhage after burr hole drainage for the treatment of chronic subdural hematoma (SDH). We present the case of a patient with this rare postoperative complication of cerebellar hemorrhage after burr hole drainage of a chronic SDH. Although burr hole drainage for the treatment of chronic SDH is rare complication, it is necessary to be aware of the possibility of cerebellar hemorrhage after supratentorial surgery, even with limited surgery such as burr hole drainage of a chronic SDH.
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Affiliation(s)
- Sang Hoon Chang
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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38
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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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FIGUEIREDO EG, AMORIM RLOD, TEIXEIRA MJ. Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights. Neurol Med Chir (Tokyo) 2009; 49:229-33; discussion 233-4. [DOI: 10.2176/nmc.49.229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Lascarrou JB, Pajot S, Daumas-Duport B, Martin S, Miguet B, Blanloeil Y. [Remote cerebellar hemorrhage]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2008; 27:938-40. [PMID: 18829242 DOI: 10.1016/j.annfar.2008.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
Intracerebral hemorrhage remote from the site of surgery is an infrequent complication after neurosurgical procedures. Cerebellar hemorrhage after supratentorial craniotomy is the most commonly described pattern of remote hemorrhage unknown by the anesthesiologist. It is linked with a frequent morbidity and mortality. We report a case of this complication after meningioma surgery with a favorable outcome.
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Affiliation(s)
- J-B Lascarrou
- Service d'anesthésie-réanimation, hôpital Nord-Laënnec, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
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41
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Kim JH, Yi HJ. Contralateral intraparenchymal hemorrhage following aneurysmal clipping. J Korean Neurosurg Soc 2008; 43:162-4. [PMID: 19096626 DOI: 10.3340/jkns.2008.43.3.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 03/18/2008] [Indexed: 11/27/2022] Open
Abstract
Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.
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Affiliation(s)
- Jae-Hoon Kim
- Department of Neurosurgery , Nowon Eulji Hospital, Seoul, Korea
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42
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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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43
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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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44
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Chernov MF, Ivanov PI. Urgent reoperation for major regional complications after removal of intracranial tumors: outcome and prognostic factors in 100 consecutive cases. Neurol Med Chir (Tokyo) 2007; 47:243-8; discussion 248-9. [PMID: 17587775 DOI: 10.2176/nmc.47.243] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Outcome of urgent reoperation for major regional complication after removal of intracranial tumor was evaluated retrospectively in 100 consecutive patients treated since 1983. Urgent reoperation was performed from 3 to 240 hours (mean 74 hours) after primary surgery for 32 meningiomas, 23 pituitary adenomas, 22 gliomas, 13 vestibular schwannomas, and 10 other intracranial neoplasms. Mean Glasgow Coma Scale (GCS) score before reoperation was 8. Brain edema was the most frequent operative finding at reoperation (31 patients), followed by extradural hematoma (25) and brain ischemia (24). Removal of various types of intracranial hematomas was the most common surgical procedure at reoperation (47 cases). Final outcome was considered favorable in 54 patients, who were discharged without major neurological deficit, and unfavorable in 46, with severe disability or vegetative state in four and death in 42. Multivariate analysis showed statistically significant association with the outcome for histological type of the tumor (p < 0.0001), clinical state at admission (p < 0.001), GCS score before urgent reoperation (p = 0.001), time interval between primary surgery and urgent reoperation (p < 0.01), and patient age (p < 0.05). Therefore, the outcome after urgent reoperation due to major regional complications after removal of intracranial tumor is determined mainly by the clinical condition of the patient and characteristics of the tumor, and less influenced by the type of complication.
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Affiliation(s)
- Mikhail F Chernov
- Department of Surgical Neurooncology, Russian A.L. Polenov Neurosurgical Institute, St. Petersburg, Russia.
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45
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Li N, Zhao W, Pu C, Shen J. Delayed hemorrhage following microvascular decompression. Three case reports. Neurol Med Chir (Tokyo) 2007; 47:186-8. [PMID: 17457025 DOI: 10.2176/nmc.47.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postoperative hemorrhage is one of the most dangerous complications following microvascular decompression (MVD), and usually occurs within the first 24 hours after MVD operation, whereas delayed hemorrhage is extremely rare. The possible mechanisms of acute and delayed postoperative hemorrhage following MVD seem to be different. Three of 685 patients treated by MVD developed delayed hematoma more than 24 hours after surgery, including two cases at the operative site and one at a remote site. The possible causes of such delayed hemorrhage are discussed. Postoperative monitoring is extremely important after the MVD procedure. If any hemorrhage can be identified at the early stage, valuable time can be won for treatment and better outcome.
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Affiliation(s)
- Ning Li
- Department of Neurosurgery, Rui jin Hospital of Shanghai Jiaotong University, Shanghai, P.R.C
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46
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Moon KS, Lee JK, Kim TS, Jung S, Kim JH, Kim SH, Kang SS. Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma. J Clin Neurosci 2007; 14:283-6. [PMID: 17258138 DOI: 10.1016/j.jocn.2005.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 11/27/2005] [Indexed: 11/22/2022]
Abstract
Supratentorial craniotomy for a nontraumatic lesion complicated by an acute subdural hematoma on the opposite side is rare. A 47-year-old woman presented with progressive headache and dizziness with no significant past history. Neuroimaging studies revealed a very large calcified chronic subdural hematoma over the entire right hemisphere with prominent mass effect. Despite a near total excision of the hematoma including the inner membranes by a large craniotomy with meticulous dissection, the brain parenchyma remained depressed. The dead space was therefore filled with saline and the operation was completed as usual. Repeat computed tomography scan for signs of left tentorial herniation demonstrated an acute contralateral subdural hematoma with severe shift of midline structures. We propose a prevention strategy for this event, which has not been previously described. We also discuss possible mechanisms involved in this unexpected complication.
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Affiliation(s)
- Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, 8 Hackdong, Dongu, Gwangju 501-757, Republic of Korea
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47
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Hyam JA, Turner J, Peterson D. Cerebellar haemorrhage after repeated burr hole evacuation for chronic subdural haematoma. J Clin Neurosci 2007; 14:83-6. [PMID: 17071089 DOI: 10.1016/j.jocn.2005.12.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 12/02/2005] [Indexed: 11/20/2022]
Abstract
We report a 79-year-old man whose third burr hole craniotomy evacuation for recurrent chronic subdural haematoma (CSDH) was complicated by cerebellar haemorrhage. The patient died 9 days later. Two previously documented cases in which this complication arose after evacuation of extra-axial collections also resulted in death. Remote cerebellar haemorrhage is a rare complication of neurosurgery but is associated with high mortality. This complication should be considered among the differential diagnoses after neurological deterioration following CSDH evacuation.
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Affiliation(s)
- Jonathan A Hyam
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom.
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48
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Vogels RLC, Verstegen MJT, van Furth WR. Cerebellar haemorrhage after non-traumatic evacuation of supratentorial chronic subdural haematoma: report of two cases. Acta Neurochir (Wien) 2006; 148:993-6. [PMID: 16804644 DOI: 10.1007/s00701-006-0800-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 03/22/2006] [Indexed: 11/30/2022]
Abstract
Cerebellar haemorrhage is an unusual complication of supratentorial neurosurgery. Several causative pre-operative factors and medical risk factors may predispose patients to cerebellar haemorrhage, however its etiology remains still unclear. Only two case reports have previously described the occurrence of cerebellar haemorrhage after subdural haematoma evacuation by burr-hole trepanation. We present two patients with this rare postoperative complication of minor supratentorial neurosurgery and possible underlying pathophysiological mechanisms are discussed. Our two cases support the post- rather than per-operative pathogenetic hypothesis. Although the complication is associated with a significant morbidity and mortality, most cases follow a benign course.
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Affiliation(s)
- R L C Vogels
- Department of Neurology, Sint Lucas-Andreas Hospital, Amsterdam, The Netherlands.
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49
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Brain shift is central to the pathogenesis of intracerebral haemorrhage remote from the site of the initial neurosurgical procedure. Med Hypotheses 2006; 67:856-9. [PMID: 16750308 DOI: 10.1016/j.mehy.2006.03.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 03/27/2006] [Indexed: 11/19/2022]
Abstract
Intracerebral haemorrhage remote from the site of surgery is an uncommon and poorly understood complication after neurosurgical procedures. Although patients under anticoagulant therapy or with perioperative elevated blood pressure are usually considered potentially at high risk of postoperative intracerebral haemorrhage, the aetiology is still unclear for patients without these predisposing factors. In this paper, we suggest that brain shift, unavoidably occurring during all neurosurgical procedures, might play a central role in the aetiology of postoperative remote intracerebral haemorrhage. Brain shift is mainly caused by gravity, aggressive intraoperative dehydration, and cerebrospinal fluid aspiration. Brain shift produces stretching and transient occlusion of the corticodural bridging veins draining into the peripheral dural sinus. Consequently, venous infarcts occur in the venous drainage territories and haemorrhagic transformation results when perfusion is re-established within ischemic tissue. To minimize brain shift and consequent risk of remote intracerebral haemorrhage, we recommend avoiding the use of hyperosmotic agents and cerebrospinal fluid drainage systems during neurosurgical procedures. Moderate head elevation during and immediately after surgery may improve cerebral venous drainage and reduces the risks of this life-threatening complication.
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Abstract
Remote cerebellar hemorrhage remains a complication rarely occurring after supratentorial surgery (<5%) and presumably even less frequent after spinal surgery. Although the pathomechanisms leading to RCH with its typical bleeding pattern are still not definitely understood, intra- or even more likely postoperative loss of larger volumes of CSF seem to be related to this complication. Prognosis significantly depends on severity of hemorrhage and patient age. Outcome in more than 50% of all cases is good with only mild remaining neurological symptoms or complete recovery, while death occurs in approximately 10-15%. Close monitoring of patients undergoing surgery that involves the risk of draining large volumes of CSF is mandatory and patients with postoperative drainage of larger amounts of fluid acquire increased attentiveness. Early detection and correct interpretation of the typical bleeding pattern might help to avoid further aggravation of symptoms. This review will address incidence, typical appearance and pathophysiological considerations, as well as risk factors, treatment options, and outcome related with RCH.
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Affiliation(s)
- Marc A Brockmann
- Department of Neuroradiology, University Hospital Mannheim, Germany.
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