Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear: A Case Report

Choi, Byung Wan; Lee, Sang Min; Yoon, Min Geun; Moon, Myung Sang

doi:10.4184/jkss.2014.21.4.183

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…This causes resultant stretching, tearing and occlusion of the cerebellar veins (superior vermian veins and superior cerebellar vein which drain in to the deep venous system), resulting in a venous infarct and venous hemorrhage or direct hemorrhage [6], [13], [17], [18]. It is similar to the "sinking brain syndrome" proposed by Kelley et al, Yoshida et al and Konig et al suggested that RCH is related to the volume of CSF drained, while Choi et al postulates that it may be the velocity of CSF drain in the peri-operative period, both which may be aggravated by negative pressure drainage [15], [19], [21]. Even with a watertight dural seal, postoperative negative pressure exerted by a subfascial drain may precipitate CSF loss between the stitches, leading to pressure shifts and hemorrhage [16].…”

Section: Pathophysiologymentioning

confidence: 59%

“…Currently, there are no established guidelines for management of post-operative RCH. Authors have recommended preventative measures, such as avoidance of excessive CSF drainage and durotomy, peri-operative blood pressure control, and correction of coagulopathies [1], [2], [4], [21].…”

Section: Treatment and Prognosismentioning

confidence: 99%

“…Clinical suspicion and early detection are critical. When patients present with neurological signs or symptoms suggestive of raised intracranial pressure following spine or supratentorial surgery, the drains should be checked for increased volumes of drained fluid (and possibly suction stopped) [21], [22]. Prompt evaluation with neuroimaging should be performed [1], [21].…”

Section: Treatment and Prognosismentioning

confidence: 99%

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Remote cerebellar hemorrhage as a complication of lumbar spine surgery

Lim¹,

Salkade²,

Peter³

2020

Radiology Case

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Remote cerebellar hemorrhage (RCH) is a rare yet potentially fatal complication of supratentorial and spinal surgery, where there has been either intentional or accidental breach of the dura. We present a case of RCH following a L4-5 decompression laminectomy complicated by an intraoperative dural tear which was detected and repaired at the time of surgery. Despite prompt intra-operative repair of the dura, there was persistent cerebrospinal fluid leak as evidenced by a high subfascial epidural drain output which resulted in bilateral intraparenchymal cerebellar hemorrhage. The patient was managed conservatively and recovered without neurological deficits.

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Section: Pathophysiologymentioning

confidence: 59%

Section: Treatment and Prognosismentioning

confidence: 99%

Section: Treatment and Prognosismentioning

confidence: 99%

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Remote cerebellar hemorrhage as a complication of lumbar spine surgery

Lim¹,

Salkade²,

Peter³

2020

Radiology Case

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“…In the present study, complaints of headache were significantly more common during the first 24 h postoperatively in the RCH group (p < 0.05). When a tentative diagnosis of RCH is made, the suction drain should be removed promptly, and the patient should be treated as soon as possible to prevent worsening of RCH 18) .…”

Section: Discussion Discussion Discussionmentioning

confidence: 99%

Incidence of Remote Cerebellar Hemorrhage in Patients with a Dural Tear during Spinal Surgery: A Retrospective Observational Analysis

Wada

Yui

Tamaki

et al. 2019

Spine Surg Relat Res

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Introduction: The incidence of remote cerebellar hemorrhage (RCH) in patients with a dural tear during spinal surgery is unclear. The purpose of this study was to determine the incidence of RCH and the causative factors in these patients.Methods: Two hundred and thirty-nine patients underwent spinal surgery at our institution between March 2015 and September 2016. Eleven of these patients needed dural suturing intraoperatively. All patients underwent CT of the head on the first postoperative day and were categorized according to whether they had RCH or not. The mean values for the amount of intraoperative bleeding, maximum perioperative blood pressure, postoperative drainage volume, and complaints of headache during the first 24 h postoperatively were compared between the two groups using the Welch's two-sample t-test and Fisher's exact test. The follow-up duration was 12 months.Results: There were four patients in the RCH group and seven in the non-RCH group. The incidence of RCH was 36.4%. There were three cerebellar hemorrhages and one interhemispheric fissure hemorrhage in the RCH group. The mean intraoperative bleeding volume was 284 mL in the RCH group and 569 mL in the non-RCH group. The mean respective values for maximum perioperative blood pressure and postoperative drainage volume were 132 mmHg and 547 mL in the RCH group and 144 mmHg and 567 mL in the non-RCH group; none of the differences was statistically significant. However, complaints of headache in the first 24 h postoperatively were significantly more common in the RCH group than in the non-RCH group (100% vs. 14.3%; p = 0.01). All patients with intracranial bleeding had recovered 3 months after surgery.Conclusions: The incidence of RCH following a dural tear during spinal surgery was 36.4%. There was a significant association between RCH and increased reporting of headache during the first 24 h postoperatively.

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Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear: A Case Report

Cited by 2 publications

References 10 publications

Remote cerebellar hemorrhage as a complication of lumbar spine surgery

Remote cerebellar hemorrhage as a complication of lumbar spine surgery

Incidence of Remote Cerebellar Hemorrhage in Patients with a Dural Tear during Spinal Surgery: A Retrospective Observational Analysis

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