Remote Cerebellar Hemorrhage Following Thoracic Spinal Surgery -Case Report-

Abstract

A 51-year-old man underwent surgery for ossification of the ligamentum flavum at the T9-T10 levels. Intraoperatively, the dura was opened unintentionally and a subcutaneous suction drain was placed. The patient complained of severe headache and nausea postoperatively. Brain computed tomography obtained 3 days after the surgery demonstrated remote cerebellar hemorrhage and hydrocephalus. Suboccipital decompression, C1 laminectomy, and ventriculostomy were performed and his symptoms subsided 2 months later. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur after any type of spinal surgery resulting in dural tear or intradural manipulation. Early diagnosis is particularly important for the treatment of remote cerebellar hemorrhage following spinal surgery.

Bilateral Supratentorial Epidural Hematomas: a Rare Complication in Adolescent Spine Surgery

“…Three distinct forms of hemorrhage associated with spinal surgery have been classified according to bleeding location: supratentorial subdural hematoma, 2,3) cerebellar hematoma, 5,7) and supratentorial epidural hematoma. 11) Intracranial epidural hematoma is most uncommon with only one case report.…”

“…In contrast, cerebellar or subdural hemorrhage related to spine surgery is of venous origin, and results from stretching of supratentorial bridge veins or cerebellar superior veins that cross the subdural space. 2,3,5,7) Compared with adolescents, the elderly or adults have larger subdural spaces, and so these veins are more vulnerable to stretching injury by intracranial hypotension in the elderly or adults than in adolescents. 2,3,5,7) Therefore, cerebellar or subdural hemorrhage mainly occurs in old or adult patients with no predilection for adolescents.…”

Intracranial hemorrhage following lumbar spine surgery

“…Cerebellar ''sag'' which is a result of excessive CSF leakage has been proposed to cause stretching and occlusion of the superior vermian veins. In patients with insufficient venous collaterals, this may cause venous infarction, subsequently leading to hemorrhagic transformation [2,[6][7][8][9][10][11][12][13][14][15] as occurred in our first and second cases. Another explanation is a rise in transmural venous pressure associated with CSF drainage and intracranial hypotension [2].…”

“…Another explanation is a rise in transmural venous pressure associated with CSF drainage and intracranial hypotension [2]. According to the experience with RCH after spinal surgery to date (30 cases), it appears that this type of hemorrhage can occur after any type of spinal surgery, in which large-volume CSF loss has occurred during or after surgery, regardless of body positioning [2,[6][7][8][9][10][11][12][13][14][15]. RCH should be suspected in any patient with unexplained deterioration of consciousness or with delayed emergence from anesthesia following spine surgery complicated by dural tear and CSF leak [2,[6][7][8][9][10][11][12][13][14][15].…”

Multiple Intracranial Hemorrhages After Cervical Spinal Surgery

“…Multiple intracranial hemorrhages have been reported in 5 cases after spinal surgery, although single hemorrhage was recognized in 7 cases. 3,4,6,[9][10][11][12] Risk factors for non-traumatic intracranial hemorrhages, such as hypertension and coagulopathy, are always considered as potential causes of postoperative bleeding. 14) Rapid reduction of ICP might be key in the development of intracranial hemorrhages after spinal sur-Neurol Med Chir (Tokyo) 52, September, 2012…”