J Korean Neurosurg Soc.  2014 Feb;55(2):103-105. 10.3340/jkns.2014.55.2.103.

Supratentorial Intraparenchymal Haemorrhages during Spine Surgery

• Leung GK
• Chan JP

• KMID: 2191055
• DOI: http://doi.org/10.3340/jkns.2014.55.2.103

Abstract

Intracranial haemorrhages are rare but potentially life-threatening complications of spine surgery. Most reported cases involved subdural or cerebellar haemorrhages; supratentorial parenchymal bleeding is very uncommon. We report a 28-year-old woman who underwent resection of a thoracic Ewing's sarcoma, and developed fatal haemorrhages around her cerebral metastases during surgery. The clinical presentations, possible pathogenesis and potential preventive measures are discussed. Patients with disseminated metastases within the neural axis are at risks of intracranial complications during spine surgery. The presence of intracranial mass lesions should be considered as a relative contraindication to intradural spine surgery.

Keyword

Cerebrospinal fluid; Complications; Haemorrhage; Neoplasm; Spine

MeSH Terms

Adult
Axis, Cervical Vertebra
Cerebrospinal Fluid
Female
Hemorrhage
Humans
Neoplasm Metastasis
Sarcoma, Ewing
Spine*

Figure

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  Fig. 1 T2-weighted magnetic resonance study shows multiple tumours in both cerebral hemispheres seven months prior.

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  Fig. 2 Pre-operative computerized tomography shows peri-tumoural oedema.

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  Fig. 3 Contrasted T1-weighted magnetic resonance study shows the spinal metastasis.

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  Fig. 4 Post-operative computerized tomography shows multiple haemorrhages around the cerebral metastases.

Reference

1. Cornips EM, Staals J, Stavast A, Rijkers K, van Oostenbrugge RJ. Fatal cerebral and cerebellar hemorrhagic infarction after thoracoscopic microdiscectomy. Case report. J Neurosurg Spine. 2007; 6:276–279. PMID: 17355028.

2. Dickerman RD, Morgan J. Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery. Spine (Phila Pa 1976). 2006; 31:1513–1514. PMID: 16741465.

3. Friedman JA, Ecker RD, Piepgras DG, Duke DA. Cerebellar hemorrhage after spinal surgery : report of two cases and literature review. Neurosurgery. 2002; 50:1361–1363. discussion 1363-1364. PMID: 12015857.

4. Jung YY, Ju CI, Kim SW. Bilateral subdural hematoma due to an unnoticed dural tear during spine surgery. J Korean Neurosurg Soc. 2010; 47:316–318. PMID: 20461178.

5. 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):2005; e215. discussion e215. PMID: 15987597.

6. Konya D, Ozgen S, Pamir MN. Cerebellar hemorrhage after spinal surgery : case report and review of the literature. Eur Spine J. 2006; 15:95–99. PMID: 16007466.

7. Nowak R, Maliszewski M, Krawczyk L. Intracranial subdural hematoma and pneumocephalus after spinal instrumentation of myelodysplastic scoliosis. J Pediatr Orthop B. 2011; 20:41–45. PMID: 20829719.

8. 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). 2002; 27:e410–e412. PMID: 12634578.

9. Turkoglu E, Kazanci B, Karavelioglu E, Sanli M, Kazanci B, Sekerci Z. Intracerebral hematoma following lumboperitoneal shunt insertion : a rare case report. Turk Neurosurg. 2011; 21:94–96. PMID: 21294099.