Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Remote Cerebellar Hemorrhage after Lumbar Spinal Surgery

  • Nam, Taek-Kyun (Department of Neurosurgery, Chung-Ang University Yongsan Hospital) ;
  • Park, Seung-Won (Department of Neurosurgery, Chung-Ang University Yongsan Hospital) ;
  • Min, Byung-Kook (Department of Neurosurgery, Chung-Ang University Yongsan Hospital) ;
  • Hwang, Sung-Nam (Department of Neurosurgery, Chung-Ang University Yongsan Hospital)
  • Published : 2009.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

Keywords

References

  1. Andrews RT, Koci TM : Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect. AJNR Am J Neuroradiol 16 : 1312-1315, 1995
  2. Bernal-Garcia LM, Cabezudo-Artero JM, Ortega-Martinez M, Fern$\acute{a}$ndez-Portales I, Ugarriza-Echebarrieta LF, Pineda-Palomo M, et al : [Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review.]. Neurocirugia (Astur) 19 : 440-445, 2008 https://doi.org/10.1016/S1130-1473(08)70211-2
  3. Bloch J, Regli L : Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage : case report. J Neurol Neurosurg Psychiatry 74 : 992-994, 2003 https://doi.org/10.1136/jnnp.74.7.992
  4. Brockmann MA, Groden C : Remote cerebellar hemorrhage : a review. Cerebellum 5 : 64-68, 2006 https://doi.org/10.1080/14734220500521032
  5. Brockmann MA, Nowak G, Reusche E, Russlies M, Petersen D : Zebra sign : Cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg 102 : 1159-1162, 2005 https://doi.org/10.3171/jns.2005.102.6.1159
  6. Calisaneller T, Yilmaz C, Ozger O, Caner H, Altinors N : Remote cerebellar haemorrhage after spinal surgery. Can J Neurol Sci 34 : 483-484, 2007 https://doi.org/10.1017/S031716710000740X
  7. Cevik B, Kirbas I, Cakir B, Akin K, Teksam M : Remote cerebellar hemorrhage after lumbar spinal surgery. Eur J Radiol 70 : 7-9, 2009 https://doi.org/10.1016/j.ejrad.2008.01.004
  8. Chadduck WM : Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery 9 : 185-189, 1981 https://doi.org/10.1227/00006123-198108000-00016
  9. Friedman JA, Ecker RD, Piepgras DG, Duke DA : Cerebellar hemorrhage after spinal surgery : report of two cases and literature review. Neurosurgery 50 : 1361-1363; discussion 1363-1364, 2002 https://doi.org/10.1097/00006123-200206000-00030
  10. Friedman JA, Piepgras DG : Remote hemorrhage. J Neurosurg 95 : 279-280, 2001
  11. G$\ddot{o}$bel F, Heidecke V, Hube R, Reichel H, Held A, Hein W : [Cerebellar hemorrhage as an early complication of spinal operations. Two case reports and review of the literature.] Z Orthop Ihre Grenzgeb 137 : 371-375, 1999 https://doi.org/10.1055/s-2008-1039729
  12. Honegger J, Zentner J, Spreer J, Carmona H, Schulze-Bonhage A : Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery : a retrospective study. J Neurosurg 96 : 248-254, 2002 https://doi.org/10.3171/jns.2002.96.2.0248
  13. Karaeminogullari O, Atalay B, Sahin O, Ozalay M, Demirors H, Tuncay C, et al : Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear : case report and literature review. Neurosurgery 57 : E215; discussion E215, 2005 https://doi.org/10.1227/01.NEU.0000163688.17385.9B
  14. Konya D, Ozgen S, Pamir MN : Cerebellar hemorrhage after spinal surgery : case report and review of the literature. Eur Spine J 15 : 95-99, 2006 https://doi.org/10.1007/s00586-005-0987-2
  15. K$\ddot{o}$nig A, Laas R, Herrmann HD : Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochir (Wien) 88 : 104-108, 1987 https://doi.org/10.1007/BF01404145
  16. Mikawa Y, Watanabe R, Hino Y, Ishii R, Hirano K : Cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion. Spine (Phila Pa 1976) 19 : 1169-1171, 1994 https://doi.org/10.1097/00007632-199405001-00015
  17. Morandi X, Haegelen C, Henaux PL, Riffaud L : Brain shift is central to the pathogenesis of intracerebral haemorrhage remote from the site of the initial neurosurgical procedure. Med Hypotheses 67 : 856-859, 2006 https://doi.org/10.1016/j.mehy.2006.03.047
  18. Papanastassiou V, Kerr R, Adams C : Contralateral cerebellar hemorrhagic infarction after pterional craniotomy : report of five cases and review of the literature. Neurosurgery 39 : 841-851; discussion 851-852, 1996 https://doi.org/10.1097/00006123-199610000-00040
  19. Satake K, Matsuyama Y, Iwata H, Sato K, Kawakami N : Cerebellar haemorrhage complicating resection of a cervical intramedullary tumour. Spinal Cord 38 : 504, 2000 https://doi.org/10.1038/sj.sc.3101020
  20. Seoane E, Rhoton AL Jr : Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 51 : 500-505, 1999 https://doi.org/10.1016/S0090-3019(97)00476-X
  21. Tafazal SI, Sell PJ : Incidental durotomy in lumbar spine surgery : Incidence and management. Eur Spine J 14 : 287-290, 2005 https://doi.org/10.1007/s00586-004-0821-2
  22. Thomas G, Jayaram H, Cudlip S, Powell M : Supratentorial and infratentorial intraparenchymal hemorrhage secondary to intracranial CSF hypotension following spinal surgery. Spine (Phila Pa 1976) 27 : E410-E412, 2002 https://doi.org/10.1097/00007632-200209150-00023
  23. Toczek MT, Morrell MJ, Silverberg GA, Lowe GM : Cerebellar hemorrhage complicating temporal lobectomy. Report of four cases. J Neurosurg 85 : 718-722, 1996 https://doi.org/10.3171/jns.1996.85.4.0718
  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

Cited by

  1. Remote cerebellar hemorrhage after lumbar spinal surgery vol.18, pp.2, 2011, https://doi.org/10.1007/s10140-010-0917-4
  2. Remote Cerebral and Cerebellar Hemorrhage after Massive Cerebrospinal Fluid Leakage vol.51, pp.4, 2009, https://doi.org/10.3340/jkns.2012.51.4.240
  3. Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms vol.21, pp.suppl4, 2009, https://doi.org/10.1007/s00586-012-2302-3
  4. Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery -A case report- vol.63, pp.3, 2009, https://doi.org/10.4097/kjae.2012.63.3.270
  5. Intracranial hemorrhage following lumbar spine surgery vol.21, pp.10, 2009, https://doi.org/10.1007/s00586-012-2187-1
  6. A case of cerebellar hemorrhage after lumbar spinal surgery vol.20, pp.4, 2009, https://doi.org/10.3918/jsicm.20.637
  7. Burr Hole Drainage : Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery? vol.53, pp.1, 2009, https://doi.org/10.3340/jkns.2013.53.1.59
  8. Remote cerebellar haemorrhage after lumbar spine surgery: case report vol.133, pp.12, 2013, https://doi.org/10.1007/s00402-013-1867-6
  9. Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery : Report of 2 cases vol.37, pp.4, 2009, https://doi.org/10.3171/2014.7.focus14294
  10. Bilateral remote cerebellar haemorrhage after spinal surgery: A case study and review of the literature vol.28, pp.9, 2014, https://doi.org/10.3109/02699052.2014.919524
  11. Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear: A Case Report vol.21, pp.4, 2009, https://doi.org/10.4184/jkss.2014.21.4.183
  12. Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery vol.2015, pp.None, 2015, https://doi.org/10.1155/2015/972798
  13. Remote Cerebellar Hemorrhage after Surgery for Degenerative Lumbar Spine Disease: A Case Report vol.11, pp.2, 2009, https://doi.org/10.13004/kjnt.2015.11.2.201
  14. Remote Cerebellar Hemorrhage after Revision Lumbar Spine Surgery vol.5, pp.6, 2009, https://doi.org/10.1055/s-0035-1567839
  15. Intracranial complications associated with spinal surgery vol.25, pp.3, 2016, https://doi.org/10.1007/s00586-015-4241-2
  16. Remote cerebellar hemorrhage after spinal procedures (part 2): a systematic review vol.39, pp.3, 2009, https://doi.org/10.1007/s10143-015-0673-8
  17. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery : An Unusual Case Report vol.60, pp.3, 2009, https://doi.org/10.3340/jkns.2014.0709.001
  18. Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression vol.9, pp.6, 2009, https://doi.org/10.1177/2192568218811317
  19. Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature vol.12, pp.12, 2009, https://doi.org/10.7759/cureus.12082
  20. Symptomatic Intracranial Hemorrhage after Dural Tear in Spinal Surgery–A Series of 10 Cases and Review of the Literature vol.150, pp.None, 2009, https://doi.org/10.1016/j.wneu.2021.02.071