Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication

Abstract

Introduction Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning. Aim A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries. Methods A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed. Results A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%). Conclusion The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post–spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.

Temporary 6TH cranial nerve paralysis after accidental durotomy in endoscopic disc surgery

“…In 2011, Abd‐Elsayed et al reported that also facial swelling due to the prone position in spinal surgery might lead to abducens nerve ischemia 6 . Al‐Saadi et al published a rare complication of intracranial hemorrhage after accidental durotomy following spinal surgery 7 . But due to the follow‐up MRI scans, no intracranial hemorrhage could be observed in our patient, so that the cause of the nerve palsy had to be evaluated otherwise.…”

“…6 Al-Saadi et al published a rare complication of intracranial hemorrhage after accidental durotomy following spinal surgery. 7 But due to the follow-up MRI scans, no intracranial hemorrhage could be observed in our patient, so that the cause of the nerve palsy had to be evaluated otherwise. To sum up, 6th nerve palsy can be caused due to alterations of intracranial pressure or mechanic injury.…”

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

“…The incidence of intracranial hemorrhage after spinal surgery in our study was 0.025% (6/24472), which was extremely low. An Egyptian study demonstrated that the incidence of intracranial hemorrhage was 0.066% (8/12185)[ 1 ]. A six-year retrospective study in Japan showed that 53 of 167106 (0.03%) patients developed hemorrhagic stroke after spinal surgery[ 8 ].…”

“…Intracranial hemorrhage after spinal surgery is a rare but disastrous postoperative complication, with poor clinical prognosis[ 1 ]. It has a heavy economic and social burden but lacks clinical data in these areas.…”

Postoperative Intracranial Hemorrhage after an Endoscopic L5-S1 Laminectomy and Discectomy: A Case Report and Literature Review

“…Postoperative intracranial hemorrhage (PIH) is a fairly rare but horrible complication that can follow endoscopic spinal surgery [ 1 , 2 , 3 ]. The incidence of PIH occurring after any spinal surgery is about 0.12% to 0.74%, as reported in the literature so far [ 4 , 5 , 6 , 7 ].…”