Intracranial hemorrhage after spine surgery

Clinical article

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  • Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Object

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.

Methods

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.

Results

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.

Conclusions

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.

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  • 1

    Andrews RT, & Koci TM: Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect. AJNR Am J Neuroradiol 16:13121315, 1995

    • Search Google Scholar
    • Export Citation
  • 2

    Beier AD, , Soo TM, & Claybrooks R: Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J 9:e9e12, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Brockmann MA, & Groden C: Remote cerebellar hemorrhage: a review. Cerebellum 5:6468, 2006

  • 4

    Brockmann MA, , Nowak G, , Reusche E, , Russlies M, & Petersen D: Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg 102:11591162, 2005

    • Search Google Scholar
    • Export Citation
  • 5

    Calisaneller T, , Yilmaz C, , Ozger O, , Caner H, & Altinors N: Remote cerebellar haemorrhage after spinal surgery. Can J Neurol Sci 34:483484, 2007

    • Search Google Scholar
    • Export Citation
  • 6

    Cevik B, , Kirbas I, , Cakir B, , Akin K, & Teksam M: Remote cerebellar hemorrhage after lumbar spinal surgery. Eur J Radiol 70:79, 2009

  • 7

    Chadduck WM: Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery 9:185189, 1981

  • 8

    Chalela JA, , Monroe T, , Kelley M, , Auler M, , Bryant T, & Vandergrift A, et al.: Cerebellar hemorrhage caused by remote neurological surgery. Neurocrit Care 5:3034, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Farag E, , Abdou A, , Riad I, , Borsellino SR, & Schubert A: Cerebellar hemorrhage caused by cerebrospinal fluid leak after spine surgery. Anesth Analg 100:545546, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Fernandez-Jara J, , Jorge-Blanco A, , Carro-Martinez AI, , Ferreiro-Argüelles C, , Fernandez-Gallardo JM, & Romero-Coronado J: Remote cerebellar hemorrhage after lumbar spinal surgery. Emerg Radiol 18:177180, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Friedman JA, , Ecker RD, , Piepgras DG, & Duke DA: Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery 50:13611364, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Gul S, , Kalayci M, & Acikgoz B: A rare complication of spinal surgery: cerebellar hemorrhage. Turk Neurosurg 20:413417, 2010

  • 13

    Hempelmann RG, & Mater E: Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms. Eur Spine J 21:Suppl 4 S564S568, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Honegger J, , Zentner J, , Spreer J, , Carmona H, & Schulze-Bonhage A: Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study. J Neurosurg 96:248254, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Karaeminogullari O, , Atalay B, , Sahin O, , Ozalay M, , Demirors H, & Tuncay C, et al.: Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review. Neurosurgery 57:1 Suppl E215, 2005

    • Search Google Scholar
    • Export Citation
  • 16

    Khalatbari MR, , Khalatbari J, & Moharamzad Y: Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 21:20922096, 2012

  • 17

    Kim DK, , Park CO, , Yoon SH, & Hyun DK: Remote cerebellar hemorrhage after spinal surgery. J Kor Neurotraumatol Soc 6:162164, 2010

  • 18

    Konya D, , Ozgen S, & Pamir MN: Cerebellar hemorrhage after spinal surgery: case report and review of the literature. Eur Spine J 15:9599, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Lee ACW, , Lau Y, , Li CH, , Wong YC, & Chiang AK: Intraspinal and intracranial hemorrhage after lumbar puncture. Pediatr Blood Cancer 48:233237, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Lee SJ, , Lin YY, , Hsu CW, , Chu SJ, & Tsai SH: Intraventricular hematoma, subarachnoid hematoma and spinal epidural hematoma caused by lumbar puncture: an unusual complication. Am J Med Sci 337:143145, 2009

    • Search Google Scholar
    • Export Citation
  • 21

    Lu CH, , Ho ST, , Kong SS, , Cherng CH, & Wong CS: Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth 49:100102, 2002

    • Search Google Scholar
    • Export Citation
  • 22

    Marquardt G, , Setzer M, , Schick U, & Seifert V: Cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 57:241252, 2002

  • 23

    McCormick PW, , Spetzler RF, , Johnson PC, & Drayer BP: Cerebellar hemorrhage associated with capillary telangiectasia and venous angioma: a case report. Surg Neurol 39:451457, 1993

    • Search Google Scholar
    • Export Citation
  • 24

    Miglis MG, & Levine DN: Intracranial venous thrombosis after placement of a lumbar drain. Neurocrit Care 12:8387, 2010

  • 25

    Mikawa Y, , Watanabe R, , Hino Y, , Ishii R, & Hirano K: Cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion. Spine (Phila Pa 1976) 19:11691171, 1994

    • Search Google Scholar
    • Export Citation
  • 26

    Morandi X, , Riffaud L, , Carsin-Nicol B, & Guegan Y: Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal. Case report. J Neurosurg 94:1 Suppl 150153, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Morofuji Y, , Tsunoda K, , Takeshita T, , Hayashi K, , Kitagawa N, & Suyama K, et al.: Remote cerebellar hemorrhage following thoracic spinal surgery. Neurol Med Chir (Tokyo) 49:117119, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Nakazawa K, , Yamamoto M, , Murai K, , Ishikawa S, , Uchida T, & Makita K: Delayed emergence from anesthesia resulting from cerebellar hemorrhage during cervical spine surgery. Anesth Analg 100:14701471, 2005

    • Search Google Scholar
    • Export Citation
  • 29

    Ozdemir O, , Calisaneller T, , Yildirim E, & Altinors N: Acute intracranial subdural hematoma after epidural steroid injection: a case report. J Manipulative Physiol Ther 30:536538, 2007

    • Search Google Scholar
    • Export Citation
  • 30

    Ozturk E, , Kantarci M, , Karaman K, , Basekim CC, & Kizilkaya E: Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery. Acta Radiol 47:497500, 2006

    • Search Google Scholar
    • Export Citation
  • 31

    Rordorf G, & McDonald C: Spontaneous intracerebral hemorrhage: pathogenesis, clinical features, diagnosis. UpToDate.com (http://www.uptodate.com/contents/spontaneous-intracerebral-hemorrhage-pathogenesis-clinical-features-and-diagnosis) [Accessed June 5, 2013]

    • Search Google Scholar
    • Export Citation
  • 32

    Sasani M, , Sasani H, & Ozer AF: Bilateral late remote cerebellar hemorrhage as a complication of a lumbo-peritoneal shunt applied after spinal arteriovenous malformation surgery. J Spinal Cord Med 33:7779, 2010

    • Search Google Scholar
    • Export Citation
  • 33

    Satake K, , Matsuyama Y, , Iwata H, , Sato K, & Kawakami N: Cerebellar haemorrhage complicating resection of a cervical intramedullary tumour. Spinal Cord 38:504, 2000

    • Search Google Scholar
    • Export Citation
  • 34

    Thomas G, , Jayaram H, , Cudlip S, & Powell M: Supratentorial and infratentorial intraparenchymal hemorrhage secondary to intracranial CSF hypotension following spinal surgery. Spine (Phila Pa 1976) 27:E410E412, 2002

    • Search Google Scholar
    • Export Citation
  • 35

    Toczek MT, , Morrell MJ, , Silverberg GA, & Lowe GM: Cerebellar hemorrhage complicating temporal lobectomy. Report of four cases. J Neurosurg 85:718722, 1996

    • Search Google Scholar
    • Export Citation
  • 36

    Yacubian EM, , de Andrade MM, , Jorge CL, & Valério RM: Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy: report of three cases. Neurosurgery 45:159162, 1999

    • Search Google Scholar
    • Export Citation
  • 37

    Yoshida S, , Yonekawa Y, , Yamashita K, , Ihara I, & Morooka Y: Cerebellar hemorrhage after supratentorial craniotomy—report of three cases. Neurol Med Chir (Tokyo) 30:738743, 1990

    • Search Google Scholar
    • Export Citation
  • 38

    You SH, , Son KR, , Lee NJ, & Suh JK: Remote cerebral and cerebellar hemorrhage after massive cerebrospinal fluid leakage. J Korean Neurosurg Soc 51:240243, 2012

    • Search Google Scholar
    • Export Citation
  • 39

    Zimmerman RM, & Kebaish KM: Intracranial hemorrhage following incidental durotomy during spinal surgery. A report of four patients. J Bone Joint Surg Am 89:22752279, 2007

    • Search Google Scholar
    • Export Citation

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