Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Multiple, Sequential, Remote Intracranial Hematomas Following Cranioplasty

  • Moon, Hong-Joo (Department of Neurosurgery Korea University Ansan Hospital Korea University School of Medicine) ;
  • Park, Ju-No (Department of Neurosurgery Korea University Ansan Hospital Korea University School of Medicine) ;
  • Kim, Sang-Dae (Department of Neurosurgery Korea University Ansan Hospital Korea University School of Medicine) ;
  • Lim, Dong-Jun (Department of Neurosurgery Korea University Ansan Hospital Korea University School of Medicine) ;
  • Park, Jung-Yul (Department of Neurosurgery Korea University Ansan Hospital Korea University School of Medicine)
  • Published : 2007.09.28
Download PDF
⟨ Previous Next ⟩

Abstract

The intracranial hemorrhage in regions remote from the site of initial operations is unusual but may present as fatal surgical complication. We report a rare case of multiple, sequential, remote intracranial hematomas after cranioplasty in a patient who did not have any prior risk factors. A 51-years-old man was transferred to the hospital after a head trauma. The brain computed tomography (CT) revealed acute subdural hemorrhage on the right hemisphere with prominent midline shifting. After performing decompressive craniectomy and hematoma removal, the patient recovered without any complications. However, the patient showed neurological deterioration immediately after cranioplasty, which was done three months after the first surgery. There was extensive hemorrhage in the posterior fossa remote from the site of the initial operation site. The brain CT taken soon after removing this hematoma evacuation displayed large epidural hematoma on the left hemisphere. This case represents posterior fossa hemorrhage after supratentorial procedure and sequential delayed hematoma on the contralateral supratentorial region thus seems very rare surgical complications. Despite several possible pathogenetic mechanisms for such remote hematomas, there are usually no clear cut relationships with each case as in our patient. However, for the successful outcome, prompt evaluation and intensive management seem mandatory.

Keywords

References

  1. Brisman MH, Bederson JB, Sen CN, Germano IM, Moore F, Post KD : Intracerebral hemorrhage occurring remote from the craniotomy site. Neurosurgery 39 : 1114-1122, 1996 https://doi.org/10.1097/00006123-199612000-00009
  2. Driesen W, Elies W : Epidural and subdural haematomas as a complication of internal drainage of cerebrospinal fluid in hydrocephalus. Acta Neurochir (Wien) 30 : 85-93, 1974 https://doi.org/10.1007/BF01405757
  3. Fiskin RD, Kurze T : Acute epidural haemorrhage complicating resection of acoustic neurinoma. J Neurosurg 21 : 58-61, 1964 https://doi.org/10.3171/jns.1964.21.1.0058
  4. Frera C : Supratentorial extradural haematomas secondary to ventricular decompression. Acta Neurochir (Wien) 20 : 31-35, 1964
  5. Fukamachi A, Koizumi H, Nagaseki Y, Nukui H : Postoperative extradural hematomas : computed tomographic survey of 1105 intracranial operations. Neurosurgery 19 : 589-593, 1986 https://doi.org/10.1227/00006123-198610000-00013
  6. Greenwald DL, Kim DH, Day Al : Remote posterior fossa hemorrhage as a complication after supratentorial craniotomy. J Neurosurg 86 : 441A, 1997
  7. Harders A, Gilsbach J, Weigel K : Supratentorial space occupying lesions following infratentorial surgery. Early diagnosis and treatment. Acta Neurochir (Wien) 74 : 57-60, 1985 https://doi.org/10.1007/BF01413279
  8. Kalfas IH, Little JR : Postoperative hemorrhage : a survey of 4992 intracranial procedures. Neurosurgery 23 : 343-347, 1988 https://doi.org/10.1227/00006123-198809000-00010
  9. Kalia KK, Swift DM, Pang D : Multiple epidural hematomas following ventriculoperitoneal shunt. Pediatr Neurosurg 19 : 78-80, 1993 https://doi.org/10.1159/000120704
  10. Kim SG, Koh YC, Um CS, Kim CH, Lee HK, Hwang DY : Acute epidural hematoma following ventriculo-peritoneal shunt operation. J Korean Neurosurg Soc 25 : 861-865, 1996
  11. KoEnig A, Laas R, Hermann HD : Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochir (Wien) 88 : 104-108, 1987 https://doi.org/10.1007/BF01404145
  12. Koller M, Ortler M, Langmayr J, Twerdy K : Posterior fossa haemorrhage after supratentorial surgery-report of three cases and review of the literature. Acta Neurochir (Wien) 141 : 587-592, 1999 https://doi.org/10.1007/s007010050347
  13. Lee SH, Eoh W, Lee KH, Chung BS : Clinical experience of delayed post-traumatic contralateral epidural hematoma. J Korean Neurosurg Soc 24 : 1361-1365, 1995
  14. Papanastassiou V, Kerr R, Adams C : Contralateral cerebellar hemorrhagic infarction after pterional craniotomy : report of five cases and review of the literature. Neurosurgery 39 : 841-852, 1996 https://doi.org/10.1097/00006123-199610000-00040
  15. Roy GC : Fracture of the skull : extensive extravation of blood on dura matter, producing compression of the brain : trepanning partial relief of symptoms, death. Lancet 2 : 319, 1884
  16. Seiler R, ZurbruEgg H : Supratentorial intracerebral hemorrhage after posterior fossa operation. Neurosurgery 18 : 472-474, 1986 https://doi.org/10.1227/00006123-198604000-00016
  17. Sinar EJ, Lindsay KW : Distant extraudral haematoma complicating removal of frontal tumors. J Neurol Neurosurg Psychiatry 49 : 442-444, 1986 https://doi.org/10.1136/jnnp.49.4.442
  18. Toczek MT, Morell MJ, Silverberg GA, Lowe GM : Cerebellar hemorrhage complicating temporal lobectomy. J Neurosurg 85 : 718-722, 1996 https://doi.org/10.3171/jns.1996.85.4.0718
  19. Tsugane R, Sugita K, Sato O : Supratentorial extradural hematomas following posterior fossa craniectomy. No Shinkei Geka 4 : 401-403, 1976
  20. Van Calenbergh F, Goffin J, Plets C : Cerebellar hemorrhage complicating supratentorial craniotomy : report of two cases. Surg Neurol 40 : 336-338, 1993 https://doi.org/10.1016/0090-3019(93)90147-S
  21. Waga S, Shimosaka S, Sakakura M : Intracerebral hemorrhage remote from the site of the initial neurosurgical procedure. Neurosurgery 13 : 662-665, 1983 https://doi.org/10.1227/00006123-198312000-00008
  22. Wolfsberger S, Gruber A, Czech T : Multiple supratentorial epidural hematomas after posterior fossa surgery. Neurosurg Rev 27 : 128-132, 2004 https://doi.org/10.1007/s10143-003-0315-4
  23. Yacubian EM, de Andrade MM, Jorge CL, Valerio RM : Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy : report of three cases. Neurosurgery 45 : 159-162, 1999 https://doi.org/10.1097/00006123-199907000-00036
  24. Yoshida S, Yonekawa Y, Yamashita K, Ihara I, Morooka Y : Cerebellar hemorrhage after supratentorial craniotomy : report of three cases. Neurol Med Chir (Tokyo) 30 : 738-743, 1990 https://doi.org/10.2176/nmc.30.738