Remote hemorrhage from the site of craniotomy

Abstract

-Postoperative intracranial hemorrhage is a serious and sometimes a fatal neurosurgical complication. Hemorrhage occurring at regions remote from the site of intracranial operations comprises an uncommon affection, most ignored by the assistant physicians. It bares a still incomprehensive pathophysiology, despite several theories trying to explain it. Looks like a common sense that the presence of the remote site hemorrhage cannot be related to concomitant presence of hypertension, coagulopathy or undiscovered lesions. We report three cases of postoperative hemorrhages occurring in a remote site of supratentorial craniotomies, two patients presented cavernous sinus meningeoma and one patient was submitted to intracranial vascular surgery.KEY WORDS: remote site hemorrhage, craniotomy, postoperative hemorrhage. Hemorragia à distância da área da craniotomiaRESUMO -Hemorragia intracraniana de ocorrência em pós-operatório é grave complicação das cirurgias intracranianas. O aparecimento de foco hemorrágico em regiões distantes ao sítio operatório original é considerado incomum, e muitas vezes ignorado pelos médicos assistentes. A fisiopatologia envolvida no processo não é de todo compreendida, apesar das diversas teorias já propostas. São apresentados três casos de hemorragia á distancia da área cirúrgica, no pós-operatório de dois pacientes portadores de meningeoma do seio cavernoso e de um submetido à clipagem de aneurisma intracraniano. PALAVRAS-CHAVE: craniotomia, hemorragia no pós-operatório.

Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

“… 4 The exact mechanisms underlying remote ICH are not fully understood, but several theories have been proposed. 2 , 5 , 6 , 7 , 8 , 9 These include altered cerebral hemodynamics, impaired autoregulation, reperfusion injury, and disruption of the blood–brain barrier.…”

Remote site extradural haematoma

“…3 There are also isolated reports of infratentorial haematoma following supratentorial surgery. 1,4 The pathophysiology of this entity is poorly understood although various hypotheses have been put forward. The loss of a substantial volume of cerebrospinal fluid (CSF) during surgery appears to be central to the pathophysiological development of remote site extradural haematoma.…”

“…The loss of a substantial volume of cerebrospinal fluid (CSF) during surgery appears to be central to the pathophysiological development of remote site extradural haematoma. 1 Suction of the CSF may cause intracranial hypotension. Further reduction of intracranial pressure leads to an increased transluminal venous pressure with subsequent rupture of vessels.…”

“…Further reduction of intracranial pressure leads to an increased transluminal venous pressure with subsequent rupture of vessels. 1 Thus, remote site extradural hemorrhage is a potentially fatal complication after supratentorial neurosurgical procedures, especially those involving the opening of CSF cisterns or the ventricular system. This condition, if detected early and treated promptly, carries an excellent prognosis.…”