Cerebellar hemorrhage complicating supratentorial craniotomy: Report of two cases

doi:10.1016/0090-3019(93)90147-S

Surgical Neurology

Volume 40, Issue 4, October 1993, Pages 336-338

https://doi.org/10.1016/0090-3019(93)90147-S Get rights and content

Abstract

One of the rare complications of supratentorial craniotomy is the occurrence of a hematoma in the cerebellum. Only seven previous cases have been published, and these have been ascribed to disturbed blood coagulation or decreased intracranial pressure. We present two similar patients, in whom, however, the pathogenetic role of these factors seems improbable.

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Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.
Cerebellar haemorrhage after repeated burr hole evacuation for chronic subdural haematoma
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Citation Excerpt :
The majority occurred after craniotomies for clipping of anterior circulation aneurysm6,8,10,12,13,15 and temporal lobe11 or skull base surgery.6,8,10 This complication has a high mortality, with eight of the 26 documented cases resulting in death.6–15 Ours is the first recorded case of a remote cerebellar haemorrhage after evacuation of a CSDH.
We report a 79-year-old man whose third burr hole craniotomy evacuation for recurrent chronic subdural haematoma (CSDH) was complicated by cerebellar haemorrhage. The patient died 9 days later. Two previously documented cases in which this complication arose after evacuation of extra-axial collections also resulted in death. Remote cerebellar haemorrhage is a rare complication of neurosurgery but is associated with high mortality. This complication should be considered among the differential diagnoses after neurological deterioration following CSDH evacuation.
Cerebellar haemorrhage following supratentorial craniotomy
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Distant cerebellar haemorrhage is a rare complication occurring in approximately 0.3–0.6% of all supratentorial craniotomy. A Medline and Pubmed search revealed only 98 cases in the English literature. We report three cases from our institution. An overall review of these 101 cases demonstrated that this complication commonly presented early in the postoperative course as decreased level of consciousness following aneurysm repair surgery or lobectomy for epilepsy. Asymptomatic presentation due to small haemorrhage was not uncommon. A transtentorial pressure gradient set up by excessive CSF loss is generally held responsible for disrupting the cerebellar venous blood flow and consequently leading to venous haemorrhage. Perioperative hypertension may also play a role. The outcome of patients who survived the complications was generally good, though not infrequently fatality resulted from the mass effect of extensive cerebellar haemorrhage demanded vigilance in its management.
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A 25 year old lady underwent surgery for a left occipital falcine meningioma. The patient was positioned prone and following an occipital carniotomy, total excision of the tumour was performed. In the postoperative period, she developed bifrontal epidural haematomas, for which surgical evacuation was performed. Intracerebral haematomas distant from the site of craniotomies are uncommon and epidural haematomas are extremely rare. The literature is reviewed and the possible mechanisms causing this complication are discussed.

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Cerebellar hemorrhage complicating supratentorial craniotomy: Report of two cases

Abstract

Surg Neurol

Surg Neurol

Cerebellar haemorrhage—diagnosis and treatment: a study of 75 consecutive cases

Quart J Med

Cerebellar hemorrhage: management and prognosis

Neurosurg Rev

L'hématome spontané du cervelet

Neurochirurgie

Hématomes intracérébelleux spontanés de l'adulte. 44 cas

Rev Neurol

Supratentorial intracerebral hemorrhage following posterior fossa surgery

J Neurosurg

Supratentorial space occupying lesions following infratentorial surgery: early diagnosis and treatment

Acta Neurochir

Cerebellar haemorrhage as a complication after supratentorial craniotomy

Acta Neurochir