Cerebellar hemorrhage after supratentorial craniotomy

Marquardt, Gerhard; Setzer, Matthias; Schick, Uta; Seifert, Volker

doi:10.1016/s0090-3019(02)00642-0

Cited by 51 publications

(40 citation statements)

References 17 publications

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“…Postoperative complications of surgical tumor resection include spontaneous intracranial hemorrhage [1][2][3]. However, postoperative brain tumor patients are also at increased risk of developing thromboembolic events (VTEs) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

et al. 2009

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Patients with brain tumors including intracranial meningiomas are at increased risk for developing deep vein thrombosis (DVTs) and suffering thromboembolic events (VTEs). Many surgeons are concerned that early use of low dose enoxaparin may increase the risk of intracranial hemorrhage which outweighs the benefit of DVT/VTE reduction. We aimed to address concerns around the use of enoxaparin after meningioma resection in the development of postoperative intracranial hemorrhages and DVT/VTEs. This is a retrospective review of 86 patients with intracranial meningiomas who underwent craniectomy and surgical resection of the mass, treated by one attending surgeon at UCSF Medical Center between 2000 and 2005. Within 48 h after surgery patients treated 2003-2005 routinely received enoxaparin therapy unless there was documented intracranial hemorrhage, lumbar subarachnoid drain, enoxaparin hypersensitivity, or thrombocytopenia (n = 24). These were compared to a cohort treated 2000-2002 who did not receive the drug (n = 62). Exclusion criteria were prior VTEs or coagulopathies. The groups were similar in tumor and surgical characteristics. Enoxaparin therapy did not increase the incidence of intracranial hemorrhage following surgical meningioma resection and the incidence of DVTs/VTEs was 0% (n = 0) versus 4.8% (n = 3) in the non-enoxaparin group. Results did not reach statistical significance. In this retrospective study, postoperative administration of enoxaparin following meningioma resection does not increase the risk of intracranial hematoma though enoxaparin administration may slightly decrease the incidence of post-surgical thromboembolic events. Due to study design and power, we were not able to demonstrate DVT/VTE reduction with statistical significance.

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Section: Introductionmentioning

confidence: 99%

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

et al. 2009

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“…Antiagregan and aspirin use are possible risk factors, in addition to age, gender, transient hypertensive episodes, coagulation disorders, arterial malformations, and sinus thrombosis. However, Marquardt et al [6] [7] showed that other than sex, the aforementioned predisposing factors were not associated with cerebellar hemorrhages. Other mechanisms implicated in RCHs are the drainage of CSF via the lamina terminalis during aneurysm surgery and the total discharge of CSF in patients following ventricular drainage.…”

Section: Discussionmentioning

confidence: 98%

Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

Yaldız¹,

Ünal²,

Akar³

et al. 2014

OJMN

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Remote cerebellar hemorrhages (RCHs) are rare complications of intracranial or spinal interventions. We describe a patient with an RCH that occurred after a frontal lobectomy for an intracranial tumor. A 41-year-old female patient with a headache and partial seizures underwent a right frontal lobectomy upon detection of a right frontal mass. An RCH (zebra sign) was detected on a control cranial computed tomography (CT), which was performed upon detection of frontal lobe syndrome and mild ataxia in the patient postoperatively. Although the mechanism underlying the occurrence of RCHs after intracranial procedures is not clear, they have been attributed to an imbalance between intravascular pressure and cerebrospinal fluid (CSF) due to rapid drainage of the fluid, causing bleeding in the cerebellar parenchyma. Generally, bilateral superior cerebellar injury produces parallel flat hyperdense areas known as the zebra sign on CT. The prognosis of a cerebellar hemorrhage is generally good, and it can be treated with a conservative approach. Controlled drainage of CSF during surgery and selecting an appropriate surgical position perioperatively will reduce the risk of RCHs.

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“…Los HCD han sido descritos como complicación de cirugía intracraneal 4,6,8,10,12,[16][17][18]22,23,27,31,[34][35][36][37][38] . Las intervenciones donde se describe con más frecuencia este tipo de complicación son la lobectomía temporal o frontal para el tratamiento de la epilepsia o la cirugía de aneurismas 10, 16,31,34 .…”

Section: Discussionunclassified

“…Sin embargo se han descrito otras más graves, como infecciones 1,20,28 , neumoencéfalo 1,14 , parálisis de cuerda vocal 28 , infarto cerebral 28 , hemorragias cerebrales múltiples 29 o herniación transtentorial 3,32 . A su vez los HCD han sido descritos como una complicación rara tras cirugía supratentorial 4,6,8,10,12,[16][17][18]22,23,27,31,34,35,[36][37][38] y, menos frecuentemente tras cirugía raquídea con apertura dural 2,7,9,11,13,19,21,25,26,30,33 , aparentemente en relación con la pérdida de LCR.…”

Section: Introductionunclassified

Hematomas de cerebelo como complicación de drenaje lumbar: Presentación de dos casos y revisión de la literatura

et al. 2008

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ResumenLos hematomas de cerebelo a distancia (HCD) son una complicación rara, consistente en la aparición de un hematoma en el cerebelo tras intervenciones quirúrgicas en áreas que no guardan relación anatómica con él. Esta complicación ha sido descrita tras cirugía supratentorial y, menos frecuentemente, tras cirugía raquídea con apertura dural con importante pérdida de líquido cefalorraquídeo (LCR).Presentamos dos pacientes con un hematoma de cerebelo tras la colocación de un drenaje lumbar externo (DLE) por sospecha diagnóstica de hidrocefalia crónica del adulto (HCA). Ambos evolucionaron favorablemente tras la retirada de los DLE. Así mismo, realizamos una revisión de la literatura sobre los mecanismos etiopatogénicos, diagnóstico, tratamiento y pronóstico de los HCD.PALABRAS CLAVE: Drenaje lumbar. Hematoma de cerebelo. Hematomas a distancia. Hidrocefalia crónica del adulto. Hidrocefalia normotensiva. Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review SummaryRemote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

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Cerebellar hemorrhage after supratentorial craniotomy

Cited by 51 publications

References 17 publications

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

Hematomas de cerebelo como complicación de drenaje lumbar: Presentación de dos casos y revisión de la literatura

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