Remote Cerebellar Hemorrhage after a Spinal Surgery Complicated by Dural Tear: Case Report and Literature Review

Karaeminoğulları, Oğuz; Atalay, Başar; Şahin, Orçun; Özalay, Metin; Demirörs, Hüseyin; Tuncay, Cengiz; Özen, Özlem; Tandoğan, Reha N.

doi:10.1227/01.neu.0000163688.17385.9b

Cited by 53 publications

(67 citation statements)

References 9 publications

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“…Failure to achieve watertight dural closure not only can increase the incidence of spinal headache, nausea, and vomiting immediately after surgery, 23,28,33 but may also predispose patients to more serious postoperative complications such as CSF leakage, CSF-cutaneous fistula, pseudomeningocele, wound infection, meningitis, and even intracranial hemorrhage. 1,14,17 Some methods of MIS dural closure have been described in the literature. Chou et al 4 reported a technique for MIS primary dural repair using a micropituitary rongeur as the needle holder in combination with a laparoscopic knot pusher commonly used in arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

Management of intended durotomy in minimally invasive intradural spine surgery

Tan¹,

Takagi²,

Straus³

et al. 2014

SPI

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Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

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Section: Discussionmentioning

confidence: 99%

Management of intended durotomy in minimally invasive intradural spine surgery

Tan¹,

Takagi²,

Straus³

et al. 2014

SPI

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“…While the focus of our report is on supratentorial procedures, it should be noted that acute loss of CSF after spinal procedures may also cause the same subarachnoid bleeding pattern in the cerebellum. 13 In our case, RCH was observed after a large amount of supratentorial CSF fluid was drained.…”

Section: Discussionmentioning

confidence: 53%

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

Mehta

Bakhsheshian

Dorafshar

et al. 2015

FOC

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The authors describe the case of a boy with Muenke syndrome, an autosomal dominant disorder associated with craniosynostosis. The family history was significant for syndromic craniosynostosis in the patient’s maternal grandmother, who died in adulthood after a craniofacial reconstruction. The patient, her grandson, underwent craniofacial reconstruction surgery at the age of 9 months and developed upward transtentorial herniation. Imaging findings revealed remote cerebellar hemorrhage after a large quantity of supratentorial CSF was drained during postoperative Day 1. The clinical course was further complicated by cerebral sinus thrombosis, which was diagnosed after a fourth surgical procedure. Upward transtentorial herniation can occur when a significant increase in intracranial pressure in the posterior fossa causes displacement of the central lobule and superior surfaces of the cerebellum upward through the incisura tentorii. This is a rare but well-documented phenomenon that commonly occurs in the setting of an expansive posterior fossa lesion or excessive supratentorial CSF loss. To help clinicians recognize and prevent this rare but potentially fatal complication, the authors review the postulated mechanisms by which this process may occur.

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“…Since then, eight more cases of patients with cerebellar haematoma after spinal operations have been published [5 (2 cases), 7,8,12,14,20,21].…”

Section: Discussionmentioning

confidence: 99%

Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

Hempelmann¹,

Mater²

2012

Eur Spine J

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Introduction Intracranial haemorrhage is a rare complication of spinal surgery. Three cases of cerebral or cerebellar haemorrhages following spinal operations with CSF loss are reported, and the literature was reviewed. Case presentations One patient suffered from melancholy after the operation, one patient had moderate headache and nausea, and the third patient suffered from mental confusion and anxiety. The intracranial haemorrhages were treated conservatively. All patients recovered from the bleedings. Results The cases show that cerebral or cerebellar haemorrhage after spinal CSF loss may be accompanied by minor or rather untypical clinical symptoms. Conclusion The dangerous complication of intracranial haemorrhage has to be kept in mind when patients have moderate cerebral symptoms after CSF loss due to spinal operations.

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Remote Cerebellar Hemorrhage after a Spinal Surgery Complicated by Dural Tear: Case Report and Literature Review

Abstract: Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Cited by 53 publications

References 9 publications

Management of intended durotomy in minimally invasive intradural spine surgery

Management of intended durotomy in minimally invasive intradural spine surgery

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

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