Remote Postoperative Epidural Hematoma after Brain Tumor Surgery

Chung, Ho-Jung; Park, Jaesung; Park, Jae-Hyun; Jeun, Sin‐Soo

doi:10.14791/btrt.2015.3.2.132

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…The mean age of patients who developed remote postoperative EDH was 41 years with all 3 patients in our study being less than 50 years. Similar results have been published by Chung et al 4 All 3 of their patients were less than 30 years and in their extensive review of literature, authors found only 1 patient of more than 50 years who had developed remote postoperative EDH. Similar findings have been reported by other authors 5 and it is safe to state that this entity is mainly seen in young and middle age group.…”

Section: Discussionsupporting

confidence: 86%

Remote extradural hematoma after supratentorial brain tumor surgery: A rare complication of a routine surgery

Punia

Chugh²,

Gotecha³

2021

Nep J Neurosci

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Background: Hemorrhages in the surgical cavity post resection of tumor aren’t uncommon and neurosurgeons are well versed with this entity, however occurrence of an Extra Dural Hematoma(EDH), that too at a site remote to the surgical cavity, is rare. The study presents 3 cases of post operative remote site EDH after tumor resection with review of literature and an attempt to define and discuss the variables which play a role in determining the occurrence, extent and prognosis of the same. Methods: The study investigated 601 patients who underwent tumor resection in the Department of Neurosurgery, Dr D Y Patil Hospital, from January 2017 to December 2019. All patients had a normal coagulation profile preoperatively. Postoperative remote EDH occurred in 3 patients whose data was examined closely in terms of age, sex, location, final diagnosis and treatment. Results: Of the 601 patients who underwent tumor resection from Jan 2017 to Dec 2019, a total of 3 patients in our study were found to have a post-operative remote site EDH. Two of these patients were male and 1 female. The age range was 35 to 46 years with a mean of 41 years. Neither did any of these patients have a pre-existing hydrocephalus nor were they subjected to a CSF diversion procedure preoperatively. All 3 patients developed EDH on the ipsilateral side wherein 2 of our patients had a hematoma in the ipsilateral frontal region anterior to the surgical cavity while 1 patient developed hematoma in ipsilateral parietal region posterior to surgical cavity. Hematomas were unilateral with no extension to opposite side. Two patients had to be re-operated in an emergency setting while one patient was conservatively managed. Conclusion: In patients with an expected volume loss via large tumor size, excess blood and CSF loss and a large craniotomy, remote EDH may develop and the neurosurgeon must have a high index of suspicion for this entity

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Section: Discussionsupporting

confidence: 86%

Remote extradural hematoma after supratentorial brain tumor surgery: A rare complication of a routine surgery

Punia

Chugh²,

Gotecha³

2021

Nep J Neurosci

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“…This hypothesis was supported by a 1986 study by Fukamachi et al, who statistically analyzed 1105 cases involving craniotomy and found that remote epidural hematoma mainly occurred in patients with hydrocephalus and/or aneurysm [ 6 ]. Recently, in 2015, Chung et al reported three cases of remote epidural hematoma after brain tumor surgery, none of which involved meningioma; therefore, this type of remote hemorrhage appears to be independent of brain tumor type [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of 14 cases of remote epidural hematoma as a postoperative complication after intracranial tumor resection

Yang

Cui

et al. 2015

World J Surg Onc

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BackgroundThe occurrence of remote epidural hematoma as a postoperative complication after intracranial tumor resection is rare. This study reviewed experiences treating these hematomas and speculated on the causes of this disease. This study reviewed the treatment experience of 14 such cases.MethodsThe 14 patients included 10 males and 4 females, with an age range of 19 to 65 years old. Six cases of tumors occurred in the sellar region, two cases in the lateral ventricle, one case in the fourth ventricle, one case in a cerebellar hemisphere, and four cases in other sites. Among them, five cases were complicated with supratentorial hydrocephalus. The tumors included five cases of meningioma tumors, two cases of pituitary adenomas, three cases of ependymomas, two cases of craniopharyngiomas, one case of astrocytoma, and one case of tuberculosis tumor. For the cases complicated with hydrocephalus, ventricular drainage was provided if needed, and the tumor resection was then performed, with close observation for postoperative changes. If neurological symptoms and disturbance of consciousness occurred, computed tomography (CT) examination was immediately performed. If a remote epidural hematoma was found, the hematoma was evacuated by craniotomy. The patients were followed up after surgery. In the five cases complicated with hydrocephalus, ventricular drainage was first provided for three cases.ResultsAll of the 14 cases underwent total tumor resection, and postoperative remote epidural hematoma occurred in all cases, including eight cases on the ipsilateral side and adjacent to the supratentorial operative field; two cases occurred on the contralateral side; two cases occurred on bilateral sides; and two cases occurred in distant areas (with infratentorial surgery, the hematoma occurred on the supratentorial area). Postoperative remote epidural hematoma usually occurred 0.5–5 h after the tumor resection, when the tentorial hernia had already occurred. Following tumor resection and epidural hematoma evacuation, 13 patients were discharged with good recovery, and one patient died.ConclusionsThe reduced intracranial pressure due to the intracranial tumor resection may be the cause of this hematoma. This type of epidural hematoma is acute and often occurs before hernia. Thus, the risk of remote epidural hematoma after intracranial tumor resection needs to be made known. Aggressive hematoma evacuation can often result in satisfactory outcomes for patients.

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“…It can occur either at the site of EVD placement or at a distant site. [ 1 ] In our case, hematoma occurred remotely at the parietal lobe on the opposite side.…”

Section: Discussionmentioning

confidence: 59%

Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis

Ezzat

Soliman

Baraka

et al. 2021

Surgical Neurology International

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Background: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping. Case Description: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site. Conclusion: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.

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Remote Postoperative Epidural Hematoma after Brain Tumor Surgery

Cited by 10 publications

References 24 publications

Remote extradural hematoma after supratentorial brain tumor surgery: A rare complication of a routine surgery

Remote extradural hematoma after supratentorial brain tumor surgery: A rare complication of a routine surgery

Retrospective analysis of 14 cases of remote epidural hematoma as a postoperative complication after intracranial tumor resection

Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis

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