Remote Cerebellar Hemorrhage after Supratentorial Aneurysmal Surgery : Report of Six Cases

The case of postoperative hemorrhage occurring apart from the operative site as a complication of intracranial surgery is a rare malady, especially when it involves the cerebellum after supratentorial aneurysm surgery. In a review of the literature, the possible etiologies for cerebellar hemorrhage are: coagulopathy, intraoperative urokinase irrigation, excessive head rotation on positioning, brain shift due to excessive cerebrospinal fluid[CSF] and epidural hemovac drainage. We experienced six cases of cerebellar hemorrhage after supratentorial aneurysm surgery, and all of the patients were improved by instituting conservative medical treatment. The possible mechanism for the remote cerebellar hemorrhages seen in our series is probably a multifactorial effect, such as excessive epidural hemovac and CSF drainage, and jugular venous compression due to the operative position. The purpose of this report is to alert neurosurgeons to the existence of this syndrome and to suggest several ways of minimizing the possibility of their patients developing remote cerebellar hemorrhage.