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

Bernal-García, L.M.; Cabezudo-Artero, J.M.; Ortega‐Martínez, Marta; Fernández-Portales, I.; Ugarriza-Echebarrieta, L.F.; Pineda-Palomo, M.; Porras-Estrada, L.F.; Gómez-Perals, L.

doi:10.1016/s1130-1473(08)70211-2

Cited by 15 publications

(8 citation statements)

References 33 publications

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“…Since RCH after spine surgery was first reported by Chadduck [2], reports of RCH have become more frequent in recent years. Even if its mechanisms are not exactly known yet despite the many opinions, many authors have reached a consensus that RCH occurs as a consequence of significant intra- or post-operative loss of CSF and is likely venous in origin [5-8]. One suggested mechanism is the increased transluminal venous pressure from the intracranical hypotension from CSF loss, which results in rupture of vessels [10].…”

Section: Discussionmentioning

confidence: 99%

“…The detection times of the neurological symptoms and RCH in previous reports were 0-72 hours and 12-120 hours after the surgery [12]. The common clinical signs were a diminished level of consciousness and headache, and other common symptoms were motor deficits and delayed emergence from anesthesia [1,6,8,12]. The diminished level of consciousness may be associated with intra-operative opioid use that can mask the presence of RCH.…”

Section: Discussionmentioning

confidence: 99%

“…One of its most likely causes, however, is intra- or post-operative cerebrospinal fluid (CSF) leakage from a damaged dura [5-8]. RCH may manifest as a headache with or without a change in consciousness that can mimic intracranial hypotension syndrome or opiate intoxication [7,8]. In its acute phase, the most common symptoms are nonspecific consciousness disorders such as disorientation or lethargy [9].…”

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confidence: 99%

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Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report-

Lee

Kim

2012

Korean J Anesthesiol

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A patient with remote cerebellar hemorrhage (RCH) who was presented at the authors' hospital with seizure and delayed emergence from anesthesia after loss of cerebrospinal fluid (CSF) through a dural tear during lumbar spine surgery is described. RCH is a rare and unpredictable complication after spinal surgery. Its most common clinical features are diminished consciousness, headache, and seizure. Its mechanism is still disputed, but is probably venous bleeding secondary to significant intra- or post-operative loss of CSF. Therefore, RCH must be considered in patients with unexplained mental deterioration or disturbance upon emergence and seizure from general anesthesia after spine surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report-

Lee

Kim

2012

Korean J Anesthesiol

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“…While hematoma at operative site is not uncommon in neurosurgery, spontaneous cerebellar hematoma remote from the site of surgery is extremely rare. [ 1 2 ] This potentially devastating complication has been described after supratentorial and spinal surgeries. While there are numerous postulates explaining the patho-physiology behind this phenomenon, these are, at best, speculative and none of these is established as yet.…”

Section: Introductionmentioning

confidence: 99%

Remote cerebellar hemorrhage: Report of 2 cases and review of literature

et al. 2014

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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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“…With regard to adult hydrocephalus, remote intracranial bleeds (most commonly cerebellar hemorrhages) have also been seen following lumboperitoneal shunting, 83 simple lumbar puncture, 9 reduction in the valve pressure of a ventriculoperitoneal shunt, 69 multiple manual pumping of a ventriculoperitoneal shunt valve, 42 and placement of an external ventricular drain. 22 All seem to have CSF loss as a common denominator.…”

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confidence: 99%

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Barami

2016

FOC

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

Cited by 15 publications

References 33 publications

Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report-

Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report-

Remote cerebellar hemorrhage: Report of 2 cases and review of literature

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

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