Remote Supratentorial Subdural Hematoma Following Craniectomy and Evacuation of Hypertensive Cerebellar Hematoma (original) (raw)
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Translational Neuroscience and Clinics
Since remote cerebellar hemorrhage, with intracerebral hemorrhage after supratentorial neurosurgery, is rare, its pathophysiology remains elusive. Here, we report a 64-year-old man who had severe bilateral symmetric remote cerebellar hemorrhage with frontal lobe hemorrhage following burr-hole evacuation for supratentorial chronic subdural hematoma. Computed tomography venography showed undeveloped left internal jugular vein and sigmoid sinus. He received 3 weeks of conservative treatment and fully recovered. Overdrainage of cerebrospinal fluid and head rotation with undeveloped internal jugular vein may have resulted in this complication. This case is the first case in the literature with this event sequence and has some significance for revealing the mechanism of remote cerebellar hemorrhage occurrence after other supratentorial surgeries.
Open Journal of Modern Neurosurgery, 2018
Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20%-40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and follow-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded patients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All functionally recovered patients were submitted for cranioplasty with either replacing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persistent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclusion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is inti-How to cite this paper: Elshanawany,
Journal of Korean Neurosurgical Society, 2009
Posterior cranial fossa subdural hematomas and extension of the subdural hematoma to the cerebellopontine angle is rarely seen and the concurrent development of acute peripheral facial palsy and the management strategy have not previously been reported in this pathology because of its rarity. We present this case to emphasize that minor head trauma may lead to a posterior cranial fossa hematoma extending to the cerebellopontine angle and cause peripheral facial palsy in patients using aspirin (acetylsalicylic acid). In addition, partial evacuation and waiting for the resorption of the hematoma may help to prevent damage to the 7th and 8th cranial nerves.
Journal of Medical Case Reports, 2014
Introduction: Decompressive surgery for acute subdural hematoma leading to contralateral extradural hematoma is an uncommon event with only few cases previously reported in the English medical literature. Case presentation: The present study describes the case of a 39-year-old White Brazilian man who had a motorcycle accident; he underwent decompressive craniectomy for the treatment of acute subdural hematoma and evolved contralateral extradural hematoma following surgery. Conclusion: The present case highlights the importance of close monitoring of the intracranial pressure of severe traumatic brain injury, even after decompressive procedures, because of the possible development of contralateral extradural hematoma.
Neurochirurgie, 2008
Bleeding after surgery for chronic subdural hematoma far from the operative site is a rare phenomenon with possibly serious consequences. We report a case of combined epidural and intracerebral hemorrhage immediately after evacuation of bilateral chronic subdural hematoma. The epidural hematoma was evacuated by emergency craniotomy, but the deep parenchymal hematoma was treated conservatively. The patient recovered progressively with a good outcome. Approximately 30 cases of chronic subdural hematomas complicated by intracerebral hematoma were previously reported, but only seven cases of epidural hematoma. These complications could be avoided if slow, gradual decompression is used during surgery. Clinicians should suspect its occurrence without delay when a postoperative neurological deterioration is demonstrated. Possible mechanisms are discussed.
Life Science Journal, 2014
Objective: Spontaneous cerebellar hemorrhage (SCH) that may cause severe brain stem compression, obstructive hydrocephalus, and cerebellar herniation is life threatening condition. Large suboccipital craniectomy has been traditionally used to evacuate SCH, which has long operative time and local tissue damage, and associated with high morbidity and mortality. We examined the effectiveness and outcome of our experience in the management of SCH with suboccipital minimal invasive "Mini-Craniectomy" (MC). Methods: This retrospective study was performed between July 2002 and August 2013 in two tertiary hospitals in the western region of Saudi Arabia for all patients were admitted with SCH. The patients were treated conservatively if they presented with Glasgow Coma Scale (GCS) of 13 or more and their computed tomography (CT) scans on admission revealed ahematoma sizeless than30 mm in maximal diameter and no evidence of brain stem compression or hydrocephalus. While, Surgical intervention with MC was considered for patients with GCS less than 13 and with CT findings of hematoma size more than 30 mm in maximal diameter, and/or brain stem compression or hydrocephalus. Glasgow outcome score (GOS) was identified for all patients at their 3-moth follow up. Results: Thirty-eight patients with SCH were included in this study with mean age of 63.5 years. Twenty-six patients (68%) were males and 12 (32%) were females. Three patients presented with GCS of 3 were offered palliative support. Non-operative management was indicated for 13 patients, and 22 patients underwent emergency MC and evacuation of cerebellar hematoma (CH). In the non-operative group, 2 patients deteriorated neurologically and underwent MC, and another patient required insertion of ventriculoperitoneal shunt (VPS) for progressive hydrocephalus. In the operative group (n= 24),2 had a local rebleed and required were reoperation, 2developed worsening of hydrocephalus and required external ventricular drains (EVD), one of them eventually requiredVPS. Suboccipital pseudomeningocele, occurred in 3 patients and resolved after 5 days of external lumbar drainage. At 3-month follow up, all patients treated conservatively (n=11) had favorable GOS.Patient who underwent MC (n=24), 19 patients (79%) had favorable GOS (3 had mild disability and 16 returned back to their baseline neurological status). Five patients (21%) had unfavorable GOS (3 patients died, 2 patients had severe disability and were dependent). Conclusion: The results of this study indicate that surgery for SCH through a MC is effective surgical procedure with good outcome. [Saleh S. Baeesa and Montasser A. Foda. Safety and Outcome of Suboccipital Mini-Craniectomy for the Evacuation of Spontaneous Cerebellar Hemorrhage. Life Sci J 2014; 11(10): 432-438] (ISSN: 1097-8135).
Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas
Journal of Korean Neurosurgical Society, 2015
or septated haematomas 14) , but are rarely recommended. Although craniotomy has been widely used in combination with inner membranectomy 27) , a higher mortality rate was demonstrated. For this reason, less invasive procedures such as subdural evacuating port systems, are currently spreading over 28). Mori and Maeda 24) reported in 2001 that post-operative acute subdural hematoma (2.6%) and tension pneumocephalus (0.8%) were the most common complications in CSH surgery. In this series, acute subdural hematoma is attributed to fresh bleeding from the scalp wound. Residual subdural fluid collections and failure of the brain to re-expand may also occur after these surgical procedures. Other post-operative complications include CSH recurrence, seizures and subdural empyema 27,30). Cortical hyperemia beneath the hematoma, subarachnoid hemorrhage (SAH), supratentorial intracerebral, intraventricular, and remote cerebellar hemorrhages (RCHs) are rarely observed. In a large series of 1000 CSH 12) , 4 cases of post-operative intracranial bleeding were described (0.4%). Other authors report an incidence range between 0.2 and 4% 8,24). In our case series, 385 CSH were operated in the Neurosurgery Unit of the