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Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery.

Watanabe S, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Sato J, Shiga Y, Abe K, Fujimoto K, Kanamoto H, Inoue G, Furuya T, Koda M, Okawa A, Takahashi K, Yamazaki M - Case Rep Orthop (2015)

Bottom Line: Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak.Leakage of cerebrospinal fluid may have induced this hemorrhage.While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.

ABSTRACT
Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

No MeSH data available.


Related in: MedlinePlus

Removal of the tumor and posterolateral fusion was performed. (a) Anteroposterior view, and (b) lateral view.
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fig2: Removal of the tumor and posterolateral fusion was performed. (a) Anteroposterior view, and (b) lateral view.

Mentions: Informed consent was received from the patient for this report. In June 2010, a 79-year-old woman presented with a 10-year history of low back pain and bilateral leg pain. Visual analogue scale (VAS) of low back pain was 5 (worst 10), right leg pain was 7, and left leg pain was 8. Motor weakness using Manual Muscle Testing (MMT) was not observed, and sensory examination using the pin prick test confirmed an abnormality of bilateral L5 dermatomes. Deep tendon reflexes were normal in both legs. There were no urinary symptoms. Bilateral straight leg raising tests results were negative. Computed tomography (CT) after myelography showed scalloping of the L4 vertebra (Figure 1). Magnetic resonance imaging (MRI) showed a low signal intensity on T1-weighted images and a high signal intensity on T2-weighted images. Gadolinium enhanced MRI showed a high signal intensity on T1-weighted images (Figure 1). Preoperative diagnosis was a Schwannoma. Because conservative treatment was not effective, surgery was planned. Surgery entailed removal of the tumor and posterolateral fusion. As the tumor was quite large (3.5 × 4.0 cm), part of dura mater (2.5 × 3.0 cm) was also removed. The dura mater was reconstructed with a synthetic patch. Posterolateral fusion was performed using pedicle screws and local bone which was grafted between the transverse processes from L3 to L5 (Figure 2). Postoperatively, leakage of CSF was noted.


Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery.

Watanabe S, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Sato J, Shiga Y, Abe K, Fujimoto K, Kanamoto H, Inoue G, Furuya T, Koda M, Okawa A, Takahashi K, Yamazaki M - Case Rep Orthop (2015)

Removal of the tumor and posterolateral fusion was performed. (a) Anteroposterior view, and (b) lateral view.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4538974&req=5

fig2: Removal of the tumor and posterolateral fusion was performed. (a) Anteroposterior view, and (b) lateral view.
Mentions: Informed consent was received from the patient for this report. In June 2010, a 79-year-old woman presented with a 10-year history of low back pain and bilateral leg pain. Visual analogue scale (VAS) of low back pain was 5 (worst 10), right leg pain was 7, and left leg pain was 8. Motor weakness using Manual Muscle Testing (MMT) was not observed, and sensory examination using the pin prick test confirmed an abnormality of bilateral L5 dermatomes. Deep tendon reflexes were normal in both legs. There were no urinary symptoms. Bilateral straight leg raising tests results were negative. Computed tomography (CT) after myelography showed scalloping of the L4 vertebra (Figure 1). Magnetic resonance imaging (MRI) showed a low signal intensity on T1-weighted images and a high signal intensity on T2-weighted images. Gadolinium enhanced MRI showed a high signal intensity on T1-weighted images (Figure 1). Preoperative diagnosis was a Schwannoma. Because conservative treatment was not effective, surgery was planned. Surgery entailed removal of the tumor and posterolateral fusion. As the tumor was quite large (3.5 × 4.0 cm), part of dura mater (2.5 × 3.0 cm) was also removed. The dura mater was reconstructed with a synthetic patch. Posterolateral fusion was performed using pedicle screws and local bone which was grafted between the transverse processes from L3 to L5 (Figure 2). Postoperatively, leakage of CSF was noted.

Bottom Line: Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak.Leakage of cerebrospinal fluid may have induced this hemorrhage.While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.

ABSTRACT
Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

No MeSH data available.


Related in: MedlinePlus