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

Abstract

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.

Surgical Treatment of Congenital Kyphosis in Children: Report of a Rare Complication of Remote Cerebellar Haemorrhage

“…Regarding the symptomatology of RCH, headache and impaired consciousness may be present, although nausea, emesis, dysarthria, seizure, diplopia, and even rapid progression towards a comatose state may take place, starting from 10 to 72 hours post-operatively [ 14 , 15 ].…”

“…The mean age of patients at the time of diagnosis of the RCH ranges from 57 to 62 years [ 9 , 15 ]. To our knowledge, this is the first reported case in the existing literature of a child suffering RCH after spinal surgery.…”

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

“…It can lead to compensatory dilatation of the venous system and downward brain shift, thus inducing intracranial hemorrhage[ 1 ]. Previous studies demonstrated that 60%-93% of intracranial hemorrhage patients had dura matter damage[ 1 , 2 , 17 ]. Therefore, surgeons must pay close attention to avoid dura tears, and if a tear occurs, they should repair the dura immediately with a waterproof closure.…”

Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis

“…Reports on the association between cerebral hemorrhage and dural injury in spine surgery have rapidly increased 2,12,13 . Intraoperative cerebrospinal fluid (CSF) leakage 2,12,13 after medical procedures at the spine, such as spine surgery 2,12,13 , dural lumbar puncture 22,23 , spinal anesthesia 24 , and myelography 25 , may be associated with intracranial hypotension and, ultimately, cerebral hemorrhage. Resection of spinal cord tumors with CSF leakage via dural incision has been associated with a high incidence of cerebral hemorrhage 2 .…”