Remote cerebellar hemorrhage following supratentorial craniotomy

Huang, Chih‐Yuan; Lee, Po-Hsuan; Lin, Sheng‐Hsiang; Chuang, Ming-Tsung; Sun, Yuan-Ting; Hung, Yao-Min; Lee, E-Jian

doi:10.1179/1743132811y.0000000072

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…Currently, most authors agree on multifactorial etiology of RCH 2) : CSF overdrainage during or after surgery, episodes of arterial hypertension, impaired venous drainage due to intraoperative head rotation with obstruction of one jugular vein, and coagulation abnormalities have been proposed. In addition, Huang et al 15) recently observed that RCH incidence after supratentorial craniotomy is related with history of cerebrovascular accident with cerebral atrophy. No consensus regarding the exact pathomechanism has been reached.…”

Section: Discussionmentioning

confidence: 99%

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

Rusconi

Sangiorgi

Bifone

et al. 2015

J Korean Neurosurg Soc

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Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

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Section: Discussionmentioning

confidence: 99%

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

Rusconi

Sangiorgi

Bifone

et al. 2015

J Korean Neurosurg Soc

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“…The zebra sign is a unique pattern caused by subarachnoid bleeding into the cerebellar sulci facing the tentorium. It is characterized as areas of alternating hyperdense blood filled sulci and hypodense cerebellar gyri, a pattern comparable to zebra skin [2], [3], [4], [5], [6], [7], [8] (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

“…Many risk factors have been associated with RCH such as hypertension, epilepsy, antiplatelets/anticoagulants, compromised coagulation status such as in liver cirrhosis, excess CSF loss during and after surgery, and old age [3], [6], [7], [8]. The mechanisms by which RCH develops are widely debated.…”

Section: Discussionmentioning

confidence: 99%

Remote cerebellar hemorrhage: A case report

Omer

Engelman

Bath

et al. 2019

Radiology Case Reports

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Remote Cerebellar Hemorrhage is a rare entity that manifests spontaneously after supratentorial craniotomy and spinal surgeries. We present a 53-year-old male who was admitted due to subdural hematoma along the left frontoparietotemporal convexity. After treatment of the subdural hematoma with craniotomy and evacuation, he developed remote cerebellar hemorrhage 1 week later. Brain computed tomography demonstrated the zebra sign. Follow-up imaging showed complete recovery without any neurologic symptoms or signs.

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“…RCH after a supratentorial craniotomy can be treated conservatively or decompressed using a ventricular drain or craniectomy with good clinical outcomes. 4,10,12,16,19 With excessive loss of CSF and RCH observed on CT imaging, drains should be discontinued to prevent exacerbation of the RCH. 4 Other authors have recommended against the use of suction drainage 11,21 and intraoperative mannitol for procedures at higher risk of RCH (hemorrhage severity and patient age).…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective cohort analysis, Huang et al were able to demonstrate a significant correlation between postoperative epidural drainage amount (221 ml, as opposed to 100 ml in the control patients) and RCH at 4 hours postoperatively. 12 Drain output should be cautiously observed for volume and quality to avoid excessive CSF drainage, especially in the immediate postoperative period. If drainage is due to scalp bleeding, removing the drain can lead to compression by an epidural hematoma, which may cause downward herniation.…”

mentioning

confidence: 99%

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

Mehta

Bakhsheshian

Dorafshar

et al. 2015

FOC

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The authors describe the case of a boy with Muenke syndrome, an autosomal dominant disorder associated with craniosynostosis. The family history was significant for syndromic craniosynostosis in the patient’s maternal grandmother, who died in adulthood after a craniofacial reconstruction. The patient, her grandson, underwent craniofacial reconstruction surgery at the age of 9 months and developed upward transtentorial herniation. Imaging findings revealed remote cerebellar hemorrhage after a large quantity of supratentorial CSF was drained during postoperative Day 1. The clinical course was further complicated by cerebral sinus thrombosis, which was diagnosed after a fourth surgical procedure. Upward transtentorial herniation can occur when a significant increase in intracranial pressure in the posterior fossa causes displacement of the central lobule and superior surfaces of the cerebellum upward through the incisura tentorii. This is a rare but well-documented phenomenon that commonly occurs in the setting of an expansive posterior fossa lesion or excessive supratentorial CSF loss. To help clinicians recognize and prevent this rare but potentially fatal complication, the authors review the postulated mechanisms by which this process may occur.

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Remote cerebellar hemorrhage following supratentorial craniotomy

Cited by 12 publications

References 16 publications

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

Remote cerebellar hemorrhage: A case report

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

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