Cerebellar Hemorrhage after Spinal Surgery: Report of Two Cases and Literature Review

Abstract

Cerebellar hemorrhage must be considered in patients with unexplained neurological deterioration after spinal surgery. Dural opening with loss of cerebrospinal fluid has occurred in every reported case of cerebellar hemorrhage complicating a spinal procedure, supporting the hypothesis that loss of cerebrospinal fluid is central to the pathogenesis of this condition. Because remote cerebellar hemorrhage can occur after procedures with the patient in the supine, sitting, and prone positions, patient positioning seems unlikely to play a causative role in its occurrence.

Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

“…The real incidence of intracranial haemorrhage due to intended or unintended CSF loss during spinal operations is not known because imaging of the brain is usually exclusively performed in symptomatic patients. But asymptomatic bleedings may be more often than expected [9,20]. The three reported cases of patients with minor or atypical symptoms support this assumption.…”

“…The authors presented a detailed literature review of ten previously published cases [2,6,9,10,18,19,22,26]. Two of these patients had additional supratentorial haematomas [19,26].…”

“…Thus, it seems plausible that the liquor loss is the main factor that causes the cerebellar and cerebral haematomas after spine surgery. A downward dislocation of the cerebellum resulting in occlusion of cerebellar veins with consequent haemorrhagic venous infarction has been postulated [9]. Others speculated that the cerebellar haemorrhage was a consequence of reperfusion after occlusion of the superior cerebellar arteries [2].…”

“…All patients shared the complication of significant spinal CSF loss prior to the onset of the clinical symptoms. However, post-operative imaging of the brain is uncommon in asymptomatic patients after a spinal procedure, thus the true incidence of RCH may be higher than suggested [9,20].…”

“…Friedman et al [9] and Konya et al [15] reported own cases of RCH after spinal surgery and conducted thorough reviews of the literature. All patients with cerebellar haemorrhage suffered from alarming symptoms such as severe headache, cerebellar signs including ataxia or dysarthria, or reduced consciousness.…”