Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
DOI:10.25259/SNI_271_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ahmed Kashkoush, Vikram Chakravarthy, Mark Bain, Iain Kalfas, Michael Steinmetz. Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization. 10-May-2021;12:221
How to cite this URL: Ahmed Kashkoush, Vikram Chakravarthy, Mark Bain, Iain Kalfas, Michael Steinmetz. Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization. 10-May-2021;12:221. Available from: https://surgicalneurologyint.com/surgicalint-articles/10793/
Background: Lumbar spine surgery with or without intraoperative dural tear (DT) may contribute to postoperative subdural hematomas and/or cerebellar intracranial hemorrhages (ICHs). Here, we present two patients, one with and one without an intraoperative DT occurring during lumbar surgery, both of whom developed acute postoperative supratentorial ICHs.
Case Description: Two patients developed supratentorial lobar ICH following lumbar decompressions and fusion. The first patient, without an intraoperative DT, developed multiple ICHs involving the left cerebellum and left temporal lobe. The second patient, following an L4-5 decompression/instrumented fusion involving a DT, postoperatively developed a large right frontal ICH.
Conclusion: Here, two patients undergoing lumbar spine surgery with/without DT subsequently developed significant ICH.
Keywords: Cerebrospinal fluid leak, Durotomy, Intracranial hemorrhage, Lobar hemorrhage, Lumbar surgery, Spine
Intracranial hemorrhage (ICH) rarely occurs following lumbar spine surgery with/without intraoperative dural tears (DTs). These ICHs are more frequently attributed to intracranial hypotension following an intraoperative durotomy (i.e., DT or cerebrospinal fluid [CSF] leak), and result in cerebellar hemorrhages, subdural hematomas/hygromas, and subarachnoid hemorrhages.[
A 72-year-old female presented with sciatica and neurogenic claudication. The lumbar MRI demonstrated significant L4-L5 central/bilateral neuroforaminal stenosis with Grade 1 spondylolisthesis [
A 61-year-old female presented with recurrent bilateral leg pain 1 year following an initial L3-5 laminectomy. The lumbar MRI now showed new right L3-4 foraminal stenosis with Grade I spondylolisthesis at the L4-L5 level [
The most common intracranial complications reported following spine surgery involving intraoperative traumatic DT include intracranial hypotension, subdural hematomas, and cerebellar ICH. These occur secondary to caudal displacement of the brain with brain sag, which leads to tearing or compression of cortical veins and dural sinuses resulting in venous infarction and hemorrhage formation.[
However, these complications can also occur following lumbar surgery without DT. For instance, one study showed that out of eight patients who sustained ICHs after spine surgery, 13% of patients had no CSF leak (1 of 8 patients).[
Most reports describe cerebellar ICH or subdural hematoma following lumbar spinal surgery with DT, but few report supratentorial lobar ICH. There are six previously reported cases of supratentorial intraparenchymal hemorrhage following spine surgery, all of which involved significant CSF leak intraoperatively.[
Here, we have presented two patients undergoing lumbar surgery with/without intraoperative DT that resulted in postoperative large ICHs.
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