Intracranial hemorrhage after spine surgery

Abstract

Object. The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome.Methods. The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery.Results. The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period.Conclusions. Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome. (http://thejns.org/doi/abs/10.3171/2013.6.SPINE12863) KEy WorDs • intracranial hemorrhage • spine surgery • cerebrospinal fluid leakAbbreviations used in this paper: CBH = cerebellar hemorrhage; ICH = intracranial hemorrhage; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage.

Intracranial epidural hemorrhage during lumbar spinal surgery

“…4,7 We routinely perform cauda equina monitoring using TcMEPs in lumbar spinal surgery intraoperatively to detect early cauda equina injury. In this patient, we were not able to detect early ICH by monitoring with TcMEPs despite the large volume of hemorrhage.…”

“…12 Despite of the fact without durotomy and dural tear, there were three patients with ICH. 4,7 But drain contained bloody CSF in all three cases. ICH can occur after any type of spinal surgery, in which CSF leakage has occurred during or after surgery.…”

“…[1][2][3][4][5][6][7][8] (Table 1) The etiology of remote ICH after spinal surgery remains unclear, but evidence suggests that it is caused by excessive CSF loss that results in cerebral dehydration, which causes stretching and eventually tearing of the bridging veins. 4,7 However, there was three cases without durotomy and dural tear. 4,7 We routinely perform cauda equina monitoring using TcMEPs in lumbar spinal surgery intraoperatively to detect early cauda equina injury.…”

“…[2][3] Kaloostain et al reported a 14% mortality rate in patients who had ICH after spinal surgery. 4 Therefore, it is important to detect ICH after spinal surgery as quickly as possible. To the best of our knowledge, there have been no reports in the English literature evaluating intraoperative cauda eqina monitoring in patients who develop ICH after spinal surgery.…”

Remote Cerebellar Hemorrhage after Supratentorial Burr-Hole Trepanation for Unilateral Chronic Subdural Hematoma: Case Report

“…1,2) Although remote cerebellar hemorrhage (RCH) is a known complication of supratentorial and spinal surgery, 3,4) to the best of our knowledge only a few cases have been published in the computed tomography (CT) era describing RCH particularly as a postoperative event following burr-hole evacuation for cSDH. [5][6][7][8][9][10][11][12] The authors contribute another report to that list, summarize the available cases of RCH in the treatment of cSDH and review the pathophysiology of RCH.…”