Intracranial hemorrhage after spine surgery

Clinical article

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The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome.


The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery.


The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period.


Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome.

Abbreviations used in this paper:CBH = cerebellar hemorrhage; ICH = intracranial hemorrhage; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage.

Article Information

Address correspondence to: Paul E. Kaloostian, M.D., Department of Neurological Surgery, The Johns Hopkins Hospital, Meyer 7-109, 600 N. Wolfe St., Baltimore, MD 21287. email:

Please include this information when citing this paper: published online July 12, 2013; DOI: 10.3171/2013.6.SPINE12863

© AANS, except where prohibited by US copyright law.



  • 1

    Andrews RTKoci TM: Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect. AJNR Am J Neuroradiol 16:131213151995

  • 2

    Beier ADSoo TMClaybrooks R: Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J 9:e9e122009

  • 3

    Brockmann MAGroden C: Remote cerebellar hemorrhage: a review. Cerebellum 5:64682006

  • 4

    Brockmann MANowak GReusche ERusslies MPetersen D: Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg 102:115911622005

  • 5

    Calisaneller TYilmaz COzger OCaner HAltinors N: Remote cerebellar haemorrhage after spinal surgery. Can J Neurol Sci 34:4834842007

  • 6

    Cevik BKirbas ICakir BAkin KTeksam M: Remote cerebellar hemorrhage after lumbar spinal surgery. Eur J Radiol 70:792009

  • 7

    Chadduck WM: Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery 9:1851891981

  • 8

    Chalela JAMonroe TKelley MAuler MBryant TVandergrift A: Cerebellar hemorrhage caused by remote neurological surgery. Neurocrit Care 5:30342006

  • 9

    Farag EAbdou ARiad IBorsellino SRSchubert A: Cerebellar hemorrhage caused by cerebrospinal fluid leak after spine surgery. Anesth Analg 100:5455462005

  • 10

    Fernandez-Jara JJorge-Blanco ACarro-Martinez AIFerreiro-Argüelles CFernandez-Gallardo JMRomero-Coronado J: Remote cerebellar hemorrhage after lumbar spinal surgery. Emerg Radiol 18:1771802011

  • 11

    Friedman JAEcker RDPiepgras DGDuke DA: Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery 50:136113642002

  • 12

    Gul SKalayci MAcikgoz B: A rare complication of spinal surgery: cerebellar hemorrhage. Turk Neurosurg 20:4134172010

  • 13

    Hempelmann RGMater E: Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms. Eur Spine J 21:Suppl 4S564S5682012

  • 14

    Honegger JZentner JSpreer JCarmona HSchulze-Bonhage A: Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study. J Neurosurg 96:2482542002

  • 15

    Karaeminogullari OAtalay BSahin OOzalay MDemirors HTuncay C: Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review. Neurosurgery 57:1 SupplE2152005

  • 16

    Khalatbari MRKhalatbari JMoharamzad Y: Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 21:209220962012

  • 17

    Kim DKPark COYoon SHHyun DK: Remote cerebellar hemorrhage after spinal surgery. J Kor Neurotraumatol Soc 6:1621642010

  • 18

    Konya DOzgen SPamir MN: Cerebellar hemorrhage after spinal surgery: case report and review of the literature. Eur Spine J 15:95992006

  • 19

    Lee ACWLau YLi CHWong YCChiang AK: Intraspinal and intracranial hemorrhage after lumbar puncture. Pediatr Blood Cancer 48:2332372007

  • 20

    Lee SJLin YYHsu CWChu SJTsai SH: Intraventricular hematoma, subarachnoid hematoma and spinal epidural hematoma caused by lumbar puncture: an unusual complication. Am J Med Sci 337:1431452009

  • 21

    Lu CHHo STKong SSCherng CHWong CS: Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth 49:1001022002

  • 22

    Marquardt GSetzer MSchick USeifert V: Cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 57:2412522002

  • 23

    McCormick PWSpetzler RFJohnson PCDrayer BP: Cerebellar hemorrhage associated with capillary telangiectasia and venous angioma: a case report. Surg Neurol 39:4514571993

  • 24

    Miglis MGLevine DN: Intracranial venous thrombosis after placement of a lumbar drain. Neurocrit Care 12:83872010

  • 25

    Mikawa YWatanabe RHino YIshii RHirano K: Cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion. Spine (Phila Pa 1976) 19:116911711994

  • 26

    Morandi XRiffaud LCarsin-Nicol BGuegan Y: Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal. Case report. J Neurosurg 94:1 Suppl1501532001

  • 27

    Morofuji YTsunoda KTakeshita THayashi KKitagawa NSuyama K: Remote cerebellar hemorrhage following thoracic spinal surgery. Neurol Med Chir (Tokyo) 49:1171192009

  • 28

    Nakazawa KYamamoto MMurai KIshikawa SUchida TMakita K: Delayed emergence from anesthesia resulting from cerebellar hemorrhage during cervical spine surgery. Anesth Analg 100:147014712005

  • 29

    Ozdemir OCalisaneller TYildirim EAltinors N: Acute intracranial subdural hematoma after epidural steroid injection: a case report. J Manipulative Physiol Ther 30:5365382007

  • 30

    Ozturk EKantarci MKaraman KBasekim CCKizilkaya E: Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery. Acta Radiol 47:4975002006

  • 31

    Rordorf GMcDonald C: Spontaneous intracerebral hemorrhage: pathogenesis, clinical features, diagnosis. ( [Accessed June 5 2013]

  • 32

    Sasani MSasani HOzer AF: Bilateral late remote cerebellar hemorrhage as a complication of a lumbo-peritoneal shunt applied after spinal arteriovenous malformation surgery. J Spinal Cord Med 33:77792010

  • 33

    Satake KMatsuyama YIwata HSato KKawakami N: Cerebellar haemorrhage complicating resection of a cervical intramedullary tumour. Spinal Cord 38:5042000

  • 34

    Thomas GJayaram HCudlip SPowell M: Supratentorial and infratentorial intraparenchymal hemorrhage secondary to intracranial CSF hypotension following spinal surgery. Spine (Phila Pa 1976) 27:E410E4122002

  • 35

    Toczek MTMorrell MJSilverberg GALowe GM: Cerebellar hemorrhage complicating temporal lobectomy. Report of four cases. J Neurosurg 85:7187221996

  • 36

    Yacubian EMde Andrade MMJorge CLValério RM: Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy: report of three cases. Neurosurgery 45:1591621999

  • 37

    Yoshida SYonekawa YYamashita KIhara IMorooka Y: Cerebellar hemorrhage after supratentorial craniotomy—report of three cases. Neurol Med Chir (Tokyo) 30:7387431990

  • 38

    You SHSon KRLee NJSuh JK: Remote cerebral and cerebellar hemorrhage after massive cerebrospinal fluid leakage. J Korean Neurosurg Soc 51:2402432012

  • 39

    Zimmerman RMKebaish KM: Intracranial hemorrhage following incidental durotomy during spinal surgery. A report of four patients. J Bone Joint Surg Am 89:227522792007




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