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

Moser, Manuel; Hildebrandt, Gerhard

doi:10.2176/nmccrj.cr.2014-0377

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Our literature search yielded 35 results (1982–2020); 25 articles met our inclusion criteria and were analyzed in detail. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Twenty-two articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study.…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were meticulously reviewed and scrutinized for their study design, methodology, and patient characteristics. Patient data were recorded when available, including age, sex, coexisting factors, use of anticoagulants/antiplatelets, cSDH side, symptoms after burr hole cSDH drainage, RICH location, time course of neurologic deterioration, treatment, and outcome ( Table 1 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ). Our case was not included in this systematic review.…”

Section: Methodsmentioning

confidence: 99%

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A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

Umana

Salvati

Fricia

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. Methods A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. Results The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25–86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0–192 hours). Conclusions RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

Umana

Salvati

Fricia

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…Our case following burr hole surgery represents a rare neurosurgical setting for post-operative RCH. To our knowledge, only two previous cases of RCH following burr hole evacuation of subdural hematomas have been described [19,20]. The proposed pathophysiology remains similar, massive and rapid evacuation of a space-occupying lesion resulting in a drastic decrease in ICP.…”

Section: Discussionmentioning

confidence: 99%

Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature

Di¹,

Wei²,

Eichberg³

et al. 2020

Cureus

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Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH.We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intraoperatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed.Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH.

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“… 6 Pure cerebellar parenchymal hemorrhage was also seen after drilling of a chronic subdural hematoma and was considered to be caused by CSF drainage and intracranial pressure changes. 12 Therefore, it can be inferred that CSF leakage may also be an important cause of the pure cerebellar parenchymal type of RCH. We believe that cerebellar collapse and decreased intracranial pressure caused by massive loss of CSF, resulting in cerebellar ischemic infarction and subsequent hemorrhage transformation, may be the cause of the pure cerebellar parenchymal type of RCH.…”

Section: Discussionmentioning

confidence: 99%

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

Liu

Yang

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Remote cerebellar hemorrhage (RCH) is an extremely rare and potentially fatal complication after supratentorial craniotomy. However, the exact pathophysiological mechanism of RCH remains unclear, so clinicians often lack clinical experience in prevention, early diagnosis, and standardized treatment. OBSERVATIONS The authors retrospectively analyzed data of patients who underwent surgery for supratentorial lesions at their center between 2012 and 2021. They identified 4 patients who developed RCH among 4,075 patients who underwent supratentorial craniotomy. All 4 patients were male, with an average age of 57.5 years. One RCH occurred after tumor resection, and the other 3 occurred after aneurysm clipping. One patient was asymptomatic and received conservative treatment with a favorable outcome. The remaining 3 patients underwent lateral ventricular drainage and/or suboccipital decompression; 2 died, and 1 recovered well. LESSONS The authors believe that RCH should be considered as a multifactorial cause, and massive cerebrospinal fluid loss plays a key role in the development and progression of RCH. Asymptomatic RCH can be treated conservatively. However, in the case of conscious disturbance, hydrocephalus, and brain stem compression, surgery should be performed immediately. Early detection and individualized treatment would be helpful to avoid potentially fatal outcomes caused by RCH.

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

Cited by 6 publications

References 22 publications

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

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