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Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature
Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient posi...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805504/ https://www.ncbi.nlm.nih.gov/pubmed/33489500 http://dx.doi.org/10.7759/cureus.12082 |
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author | Di, Long Wei, Grace Eichberg, Daniel G Komotar, Ricardo J Ivan, Michael |
author_facet | Di, Long Wei, Grace Eichberg, Daniel G Komotar, Ricardo J Ivan, Michael |
author_sort | Di, Long |
collection | PubMed |
description | Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH. We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intra-operatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed. Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH. |
format | Online Article Text |
id | pubmed-7805504 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-78055042021-01-21 Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature Di, Long Wei, Grace Eichberg, Daniel G Komotar, Ricardo J Ivan, Michael Cureus Neurosurgery Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH. We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intra-operatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed. Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH. Cureus 2020-12-14 /pmc/articles/PMC7805504/ /pubmed/33489500 http://dx.doi.org/10.7759/cureus.12082 Text en Copyright © 2020, Di et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Neurosurgery Di, Long Wei, Grace Eichberg, Daniel G Komotar, Ricardo J Ivan, Michael Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title | Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title_full | Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title_fullStr | Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title_full_unstemmed | Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title_short | Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature |
title_sort | remote cerebellar hemorrhage associated with intra-operative cerebrospinal fluid leak: a report of two rare case presentations and review of the literature |
topic | Neurosurgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805504/ https://www.ncbi.nlm.nih.gov/pubmed/33489500 http://dx.doi.org/10.7759/cureus.12082 |
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