Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Remote Cerebellar Hemorrhage Complicated after Supratentorial Surgery: Retrospective Study with Review of Articles

  • Park, Jae-Suk (Department of Neurosurgery, Kyungpook National University School of Medicine) ;
  • Hwang, Jeong-Hyun (Department of Neurosurgery, Kyungpook National University School of Medicine) ;
  • Park, Jae-Chan (Department of Neurosurgery, Kyungpook National University School of Medicine) ;
  • Hamm, In-Suk (Department of Neurosurgery, Kyungpook National University School of Medicine) ;
  • Park, Yeun-Mook (Department of Neurosurgery, Kyungpook National University School of Medicine)
  • Published : 2009.08.28
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Abstract

Objective: Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. Methods: We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. Results: There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. Conclusion: RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

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References

  1. Amini A, Osborn AG, McCall TD, Couldwell WT : Remotecerebellar hemorrhage. AJNR Am J Neuroradiol 27 : 387-390, 2006
  2. Bilginer B, Oguz KK, Akalan N, Spencer DD : Remote cerebellarhemorrhage and iliofemoral vein thrombosis after supratentorialcraniotomy. Neurocrit Care 8 : 283-285, 2008 https://doi.org/10.1007/s12028-007-9027-x
  3. Brisman MH, Bederson JB, Sen CN, Germano IM, Moore F, Post K : Intracerebral hemorrhage occurring remote from the craniotomy site. Neurosurgery 39 : 1114-1121; discussion 1121-1122, 1996 https://doi.org/10.1097/00006123-199612000-00009
  4. Brockmann MA, Groden C : Remote cerebellar hemorrhage : a review. Cerebellum 5 : 64-68, 2006 https://doi.org/10.1080/14734220500521032
  5. Brockmann MA, Nowak G, Reusche E, Russlies M, Petersen D : Zebrasign : cerebellar bleeding pattern characteristic of cerebrospinal fluidloss. Case report. J Neurosurg 102 : 1159-1162, 2005 https://doi.org/10.3171/jns.2005.102.6.1159
  6. Chadduck WM : Cerebellar hemorrhage complicating cervicallaminectomy. Neurosurgery 9 : 185-189, 1981 https://doi.org/10.1227/00006123-198108000-00016
  7. Cloft HJ, Matsumoto Ja, Lanzino G, Cail WS : Posterior fossahemorrhage after supratentorial surgery. AJNR Am J Neuroradiol 18 :1573-1580, 1997
  8. Dunne JW, Chakera T, Kermode S : Cerebellar hemorrhage - diagnosisand treatment : a study of 75 consecutive cases. Q J Med 64 : 739-754, 1987
  9. Farag E, Abdou A, Riad I, Borsellino SR, Schubert A : Cerebellarhemorrhage caused by cerebrospinal fluid leak after spine surgery.Anesth Analg 100 : 545-546, 2005 https://doi.org/10.1213/01.ANE.0000143340.51813.6A
  10. Friedman JA, Piepgras DG, Duke DA, McClelland RL, Bechtle PS,Maher CO, et al. : Remote cerebellar hemorrhage after supratentorialsurgery. Neurosurgery 49 : 1327-1340, 2001 https://doi.org/10.1097/00006123-200112000-00008
  11. Gelfenbeyn M, Vasil’ev S, Krylov V : Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage. NeurosurgRev 24 : 214-219, 2001 https://doi.org/10.1007/s101430000144
  12. Honegger J, Zentner J, Spreer J, Carmona H, Schulze-Bonhage A :Cerebellar hemorrhage arising postoperatively as a complication ofsupratentorial surgery : a retrospective study. J Neurosurg 96 : 248-254, 2002 https://doi.org/10.3171/jns.2002.96.2.0248
  13. Ikakura K, Nakazawa S, Kuzuhara M, Nakae S : A case of cerebellarhematoma after supratentorial craniotomy. Kanto J Japanese AssocAcute 9 : 342-344, 1998
  14. Jang JW, Joo SP, Kim JH, Kim SH : Remote cerebellar hemorrhageafter supratentorial aneurismal surgery : report of six cases. J KoreanNeurosurg Soc 39 : 370-373, 2006
  15. Kang YG, Chung H, Lee SP, Choi KH, Yeo HT, Rhee JK : Remoteintracerebral hematoma after supratentorial graniotomy. J KoreanNeurosurg Soc 25 : 1910-1916,1996
  16. Kaplan SS, Lauryssen C : Cerebellar hemorrhage after evacuation ofan acute supratentorial subdural haematoma. Br J Neurosurg 13 :329-331, 1999 https://doi.org/10.1080/02688699943790
  17. Koller M, Ortler M, Langmayr J, Twerdy K : Posterior-fossa haemorrhageafter supratentorial surgery--report bof three cases and reviewof the literature. Acta Neurochir (Wien) 141 : 587-592, 1999 https://doi.org/10.1007/s007010050347
  18. Konya D, Ozgen S, Pamir MN : Cerebellar hemorrhage after spinalsurgery : case report and review of the literature. Eur Spine J 15 : 95-99, 2006 https://doi.org/10.1007/s00586-005-0987-2
  19. K$\ddot{o}$nig A, Laas R, Herrmann HD : Cerebellar haemorrhage as acomplication after supratentorial craniotomy. Acta Neurochir(Wien) 88 : 104-108, 1987 https://doi.org/10.1007/BF01404145
  20. Kuroda R, Nakatani J, Akai F, Sato M, Kataoka K, Isaka T, et al. :Remote subarachnoid haemorrhage in the posterior fossa followingsupratentorial surgery. Clinical observation of 6 cases. Acta Neurochir(Wien) 129 : 158-165, 1994 https://doi.org/10.1007/BF01406496
  21. Lee JW, Yim MB, Lee JC, Son EI, Kim DW, Kim IH : Intracerebralhemorrhage remote from the site of aneurysm surgery. J KoreanNeurosurg Soc 25 : 834-841, 1996
  22. Marquardt G, Setzer M Schick U, Seifert V : Cerebellar hemorrhageafter supratentorial craniotomy. Surg Neurol 57 : 241-251; discussion251-252, 2002 https://doi.org/10.1016/S0090-3019(02)00642-0
  23. Maruyama T, Ishii K, Isono M, Abe T, Fujiki M, Kobayashi H :Remote cerebellar hemorrhage following supratentorial craniotomy--case report. Neurol Med Chir (Tokyo) 44 : 294-297, 2004 https://doi.org/10.2176/nmc.44.294
  24. Miyamoto Y, Nakasu S, Nakasu Y, Handa J : [Postoperative intracerebral hematoma remote from the site of craniotomy.] Neuro MedChir (Tokyo) 25 : 219-222, 1985 https://doi.org/10.2176/nmc.25.219
  25. Modesti LM, Hodge CH, Barnwell ML : Intracerebral hematomaafter evacuation of chronic extracerebral fluid collections. Neurosurgery10 : 689-693, 1982 https://doi.org/10.1227/00006123-198206010-00002
  26. Papanastassiou V, Kerr R, Adams C : Contralateral cerebellar hemorrhagic infarction after pterional craniotomy : report of five cases andreview of the literature. Neurosurgery 39 : 841-851; discussion 851-852, 1996 https://doi.org/10.1097/00006123-199610000-00040
  27. Park SJ, Oh SM, Shin DI, Park SH : Remote intracerebral hemorrhage complicating aneurysm surgery. J Korean Neurosurg Soc 28 : 532-40, 1999
  28. Seoane E, Rhoton AL Jr : Compression of the internal jugular vein bythe 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
  29. Siu TL, Chandran KN, Siu T : Cerebellar hemorrhage followingsupratentorial craniotomy. J Clin Neurosci 10 : 378-384, 2003 https://doi.org/10.1016/S0967-5868(03)00024-9
  30. Srikijvilaikul T, Deesudchit T : Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy : report of two cases. J MedAssoc Thai 90 : 1221-1224, 2007
  31. Toczek MT, Morell MJ, Silverberg GA, Lowe GM : Cerebellarhemorrhage complicating temporal lobectomy. Report of four cases. JNeurosurg 85 : 718-722, 1996 https://doi.org/10.3171/jns.1996.85.4.0718
  32. Tomii M, Nakajima M, Ikeuchi S, Ogawa T, Abe T : [Infratentorialhemorrhage following supratentorial surgery.] No Shinkei Geka 27 :921-925, 1999
  33. Tucker A, Miyake H, Tsuji M, Ukita T, Nishihara K : Remote cerebellar hemorrhage after supratentorial unruptured aneurysmal surgery: report of three cases. Neurol Res 29 : 493-499, 2007 https://doi.org/10.1179/016164107X164094
  34. van Calenbergh F, Goffin J, Plets C : Cerebellar hemorrhage complicating supratentorial craniotomy : report of two cases. Surg Neurol40 : 336-338, 1993 https://doi.org/10.1016/0090-3019(93)90147-S
  35. Yacubian EM, de Andrade MM, Jorge CL, Valério RM : Cerebellarhemorrhage after supratentorial surgery for treatment of epilepsy :report of three cases. Neurosurgery 45 : 159-162, 1999 https://doi.org/10.1097/00006123-199907000-00036
  36. Vogels RLC, Verstegen MJ, van Furth WR : Cerebellar haemorrhage after non-traumatic evacuation of supratentorial chronic subduralhaematoma : report of two cases. Acta Neurochir (Wien) 148 : 993-996, 2006 https://doi.org/10.1007/s00701-006-0800-y
  37. Waga S, Shimosaka S, Sakakura M : Intracerebral hemorrhageremote from the site of the initial neurosurgical procedure. Neurosurgery13 : 662-665, 1983 https://doi.org/10.1227/00006123-198312000-00008
  38. Yasagil MG, Yonekawa Y : Results of microsurgical extra-intracranialarterial bypass in the treatment of cerebral ischemia. Neurosurgery 1 :22-24, 1977 https://doi.org/10.1227/00006123-197707000-00005
  39. Yoshida S, Yonekawa Y, Yamashita K, Ihara I, Morooka Y : Cerebellar hemorrhage after supratentorial craniotomy--report of three cases.Neurol Med Chir (Tokyo) 30 : 738-743, 1990 https://doi.org/10.2176/nmc.30.738

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