Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Remote Cerebellar Hemorrhage after Supratentorial Aneurysmal Surgery : Report of Six Cases

  • Jang, Jae-Won (Departments of Neurosurgery, Chonnam National University Hospital, Medical School) ;
  • Joo, Sung-Pil (Departments of Neurosurgery, Chonnam National University Hospital, Medical School) ;
  • Kim, Jae-Hyoo (Departments of Neurosurgery, Chonnam National University Hospital, Medical School) ;
  • Kim, Soo-Han (Departments of Neurosurgery, Chonnam National University Hospital, Medical School)
  • Published : 2006.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

The case of postoperative hemorrhage occurring apart from the operative site as a complication of intracranial surgery is a rare malady, especially when it involves the cerebellum after supratentorial aneurysm surgery. In a review of the literature, the possible etiologies for cerebellar hemorrhage are: coagulopathy, intraoperative urokinase irrigation, excessive head rotation on positioning, brain shift due to excessive cerebrospinal fluid[CSF] and epidural hemovac drainage. We experienced six cases of cerebellar hemorrhage after supratentorial aneurysm surgery, and all of the patients were improved by instituting conservative medical treatment. The possible mechanism for the remote cerebellar hemorrhages seen in our series is probably a multifactorial effect, such as excessive epidural hemovac and CSF drainage, and jugular venous compression due to the operative position. The purpose of this report is to alert neurosurgeons to the existence of this syndrome and to suggest several ways of minimizing the possibility of their patients developing remote cerebellar hemorrhage.

Keywords

References

  1. Araki Y, Andoh H, Yamada M, Nakatani K, Andoh T, Sakai N : Permissible arterial occulusion time in aneurysm surgery : postoperative hyperperfusion caused by temporary clipping. Neurol Med Chir 39 : 901906, 1999
  2. Brisman MH, Bederson JB, Sen CN, Germano IM, Moore F, Post K : Intracerebral hemorrhage occurring remote from the craniotomy site. Neurosurgery 39 : 1114-1122, 1996 https://doi.org/10.1097/00006123-199612000-00009
  3. Calenbergh F, Goffin J, Plets C : Cerebellar hemorrhage complicating supratentorial craniotomy : report of two cases. Surg Neurol 40 : 336-338, 1993 https://doi.org/10.1016/0090-3019(93)90147-S
  4. Chadduck WM : Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery 9 : 185-189, 1981 https://doi.org/10.1227/00006123-198108000-00016
  5. Friedman JA, Piepgras DG, Duke DA, McClelland RL, Bechtle PS, Maher CO, et al : Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery 49 : 1327-1340, 2001 https://doi.org/10.1097/00006123-200112000-00008
  6. Honegger J, Zentner J, Spreer J, Carmona H, Schulze-Bonhage A : Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery : a retrospctive study. J Neurosurgery 96 : 248-254, 2002 https://doi.org/10.3171/jns.2002.96.2.0248
  7. Jeon KH, Kim SH, Koh HS, Youm JY, Song SH, Kim Y : Clinical analysis of cerebellar hemorrhage after supratentorial surgery. J Korean Brain Tumor Soc 4 : 26-31, 2005
  8. Kalfas I, Little J : Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery 23 : 343-347, 1998 https://doi.org/10.1227/00006123-198809000-00010
  9. Kang YG, Chung H, Lee SP, Choi KH, Yeo HT, Rhee JK : Remote intracerebral hematoma after supratentorial craniotomy. J Korean Neurosurg Soc 25 : 1910-1916, 1996
  10. Koller M, Ortler M, Langmayr J, Twerdy K : Posterior fossa haemorrhage after supratentorial surgery. Acta Neurochir (Wien) 141 : 587-592, 1999 https://doi.org/10.1007/s007010050347
  11. Konig A, Laas R, Herrmann H : Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochir 88 : 104-108, 1987 https://doi.org/10.1007/BF01404145
  12. Lee JW, Yim MB, Lee JC, Son EI, Kim DW, Kim IH : Intracerebral hemorrhage remote from the site of aneurysm surgery. J Korean Neurosurg Soc 25 : 831-841, 1996
  13. Melamed N, Satya- M : Cerebellar hemorrhage : a review and reappraisal of benign cases. Acta Neurol 41 : 425-428, 1984
  14. Mikhail G, Sergey V, Vladmir K : Cerebellar hemorrhage after supratentorial aneurysm surgery with lumbar drainage. Neurosurgery Rev 24 : 214-219, 2001
  15. Park SJ, Oh SM, Shin DI, Park SH : Remote intracerebral hemorrhage complicating aneurysm surgery. J Korean Neurosurg Soc 28 : 532-540, 1999
  16. Seoane E, Rhoton AL : Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 51 : 500-505, 1999 https://doi.org/10.1016/S0090-3019(97)00476-X
  17. Siu TL, Chandran KN, Siu T : Cerebellar hemorrhage following supratentorial craniotomy. J Clin Neurosci 10 : 378-384, 2003 https://doi.org/10.1016/S0967-5868(03)00024-9
  18. Toczek MT, Morell MJ, Silverberg GA, Lowe GM : Cerebellar hemorrhage complicating temporal lobectomy. J Neurosurgery 85 : 718-722, 1996 https://doi.org/10.3171/jns.1996.85.4.0718
  19. Waga S, Shimosaka S, Sakakura M : Intracerebral hemorrhage remote from the site of the initial neurosurgical procedure. Neurosurgery 13 : 662-665, 1983 https://doi.org/10.1227/00006123-198312000-00008
  20. Yoshida S, Yonekawa Y, Yamashita K : Cerebellar hemorrhage after supratentorial craniotomy : report of three cases. Neurol Med Chir 30 : 738-743, 1990 https://doi.org/10.2176/nmc.30.738