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

Abstract

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.

Remote cerebellar hemorrhage as complication of spinal surgery

“…It is considered one of the most serious complications of spinal surgery, being potentially lethal 3,7,8,9,13 . Its appearance after supratentorial interventions is already well known, with an incidence ranging from 0.2% to 4.9% [1][2][3][7][8][9][10][11][12][13][14] . The operations that more likely present with this complication are frontal or temporal lobectomy for epilepsy treatment and excision of aneurysms 1,6,7,8 .…”

“…The occurrence of RCH as a complication of spinal surgery was first reported after a cervical laminectomy and, since then, has been reported after procedures in all spine levels 12 . Its incidence has been progressively increasing in recent years but is still significantly lower than after supratentorial procedures 1,2,7 . This difference in incidence can be explained by the fact that most of RCH cases remain asymptomatic, being diagnosed incidentally by cranial CT for postoperative control.…”

“…Clinically, RCH can be present as cerebellar syndrome, headaches or dizziness, which usually appears between 10 and 120 hours after surgery 1,12 . Symptoms vary depending on location and extent of bleeding 2 .…”

“…The occurrence of remote cerebellar hemorrhage (RCH) after neurological surgery is a rare but well known complication [1][2][3][5][6][7][8][9]13,14 , with the majority of cases being seen after supratentorial intracranial procedures 1,[6][7][8][9]10,12,14 ; however its occurrence in the intercourse of spinal surgery has been described more frequently in recent years. It was first described by Chadduck 4 in 1981 and, since then, many theories have been proposed to explain the origin and when such bleeding occurs: the theory of the cerebellar sagging with distention of the vermian veins is more widely accepted, however, some uncertainties persist [1][2][3]5,6,7,9,[11][12][13][14] . At the moment, what it's known for sure is that for the occurrence of this complication is necessary an opening in the duramater with loss of cerebrospinal fluid [1][2][3]5,6,7,9,[11][12][13][14] .…”

“…It was first described by Chadduck 4 in 1981 and, since then, many theories have been proposed to explain the origin and when such bleeding occurs: the theory of the cerebellar sagging with distention of the vermian veins is more widely accepted, however, some uncertainties persist [1][2][3]5,6,7,9,[11][12][13][14] . At the moment, what it's known for sure is that for the occurrence of this complication is necessary an opening in the duramater with loss of cerebrospinal fluid [1][2][3]5,6,7,9,[11][12][13][14] . The treatment to be instituted depends primarily on the patient's neurological status and extent of injury 2,7 .…”