Brainstem hemorrhage following clipping of anterior communicating aneurysm: Is lumbar drain responsible?

Abstract

Remote brainstem hemorrhage is an extremely rare complication following supratentorial surgery. We describe here a 55-year-old patient with ruptured anterior communicating artery aneurysm, who underwent an uneventful clipping of the aneurysm, and had a lumbar drainage intra-operatively to facilitate brain relaxation. In the postoperative period, he developed pontomesencephalic hemorrhage, and had a fatal outcome. The potential causative factors are discussed, and the relevant literature reviewed. This is probably the first reported case of this complication in the literature.

Brain Stem Hemorrhage after Insertion of a Lumbar Drain: An Extremely Rare but Fatal Complication of a Routine Procedure

“…ICH can occur in various forms such as cerebellar hemorrhage, cerebral parenchymal hemorrhage, BSH, subarachnoid hemorrhage, and subdural hemorrhage. [7][8][9][10][11][12] Several cases of ICH after spinal surgery have been reported, probably due to CSF overdrainage. [9][10][11][12] To date, only a very small number of cases of BSH after LD have been reported in the literature.…”

“…[7][8][9][10][11][12] Several cases of ICH after spinal surgery have been reported, probably due to CSF overdrainage. [9][10][11][12] To date, only a very small number of cases of BSH after LD have been reported in the literature. Kakati et al reported a case of BSH, in which LD was done intraoperatively to facilitate relaxation of the brain during aneurysmal clipping.…”

“…Kakati et al reported a case of BSH, in which LD was done intraoperatively to facilitate relaxation of the brain during aneurysmal clipping. 9 Yuan et al reported a case in which LD was done for intracerebral hemorrhage with ventricular involvement. Overdrainage of CSF resulted in BSH and transtentorial herniation.…”

“…CSF hypovolemia leading to cerebellar collapse, stretching, and occlusion of cerebellar veins causes hemorrhagic infarction, and distortion of intraparenchymal vessels leads to rupture, which in turn results in hematoma formation. [9][10][11][12][13] The mechanism of the development of BSH is still under research and is subject to debate. Perforating pontine artery deformation occurs due to downward transtentorial herniation following overdrainage of the CSF, leading to rupture and hematoma formation.…”