• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.118-120
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• 2013

We report a rare case of remote cerebellar hemorrhage after intradural disc surgery at the L1-2 level. Two days after the spine surgery, patient complained unexpected headache, dizziness, nausea and vomiting. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage. Occipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed. After occipital craniotomy, the patient showed signs of improvement on headache, dizziness, nausea and vomiting. He was able to leave the hospital after two weeks of initial operation without any neurological deficit. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur from dural damage of spinal surgery, accompanied with cerebrospinal fluid leakage. Early diagnosis is particularly important for the optimal treatment of remote cerebellar hemorrhage.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.228-231
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• 2007

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.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.370-373
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• 2006

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.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.501-504
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• 2009

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.

• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.240-243
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• 2012

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.367-370
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• 2017

Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.405-408
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• 2008

GBM is the most common primary brain tumor, but intraventricular GBM is rare and only few cases have been reported in the literature. The authors report a case of 64-year-old man who had a remote history of previous periventricular intracerebral hemorrhage. Brain computed tomography (CT) and magnetic resonance (MR) imaging showed an intraventricular lesion with inhomogeneous enhancement, infiltrative borders and necrotic cyst, and obstructive hydrocephalus. The patient underwent surgical removal through transcortical route via the bottom of previous hemorrhage site and the final pathologic diagnosis was GBM. We present a rare case of an intraventricular GBM with detailed clinical course, radiological findings, and pathological findings, and the possible origin of this lesion is discussed.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.136-143
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• 2009

Objective: Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. Methods: We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. Results: There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. Conclusion: RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1997년도 제36차 춘계학술대회 초록집
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• pp.148-148
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• 1997

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.379-385
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• 2015

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.