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Choi, Lee, Yoon, and Moon: Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear - A Case Report -
Case Report

Journal of Korean Spine Surg 2014;21(4):183-188.

Published online: 21 December 2014

DOI: https://doi.org/10.4184/jkss.2014.21.4.183

Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear - A Case Report -

Byung Wan Choi, M.D., Sang Min Lee, M.D.∗, Min Geun Yoon, M.D.∗, Myung Sang Moon, M.D.∗

Spine center, Haeundae Paik Hospital, Inje University, Busan, Korea

∗Spine ceter, Dept of Orthopedic Surgery, Cheju Halla General Hospital, Jeju, Korea

Corresponding author: Sang Min Lee, M.D. Department Orthopaedic Surgery Jeju Halla General Hospital 65 Doreongno, Jeju City, Jeju Province, 690-170, Republic of Korea TEL: +82-64-740-5410, FAX: +82-64-743-3110 E-mail: mingy9879@gmail.com

Received 4 May 2014       Revised 4 July 2014       Accepted 2 December 2014

Copyright © 2014 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression and lumbar interbody fusion (PILF).

Summary of Literature Review

Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause is known to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosis and treatment of RCH is very important in the patient with suspicious symptoms.

Materials and Methods

A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosis at L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developed nausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservatively managed with clamping of the wound drainage.

Results

The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapy at postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2 weeks.

Conclusions

Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treating surgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small.

Keywords: Cerebellar Hemorrhage, CSF, Dura, tear, Lumbar vertebrae

REFERENCES

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Figures and Tables%

Fig. 1.
Sagittal view (A) of preoperative MRI shows spondylolisthesis with dural compression at L4-5 level. Axial view (B) shows severe dural compression due to both facet joint and ligamentum flavum hypertrophy.
jkss-21-183f1.tif
Fig. 2.
Immediate postoperative AP (A) and Lateral (B) x-rays show posterior decompression and reduced spondylolisthesis after posterior lumbar interbody fusion at L4-5 level.
jkss-21-183f2.tif
Fig. 3.
Brain CT of postoperative day 1 (A) shows small amount of hemorrhage (black arrow) in cerebellum. Amount of cerebellar hemorrhage increased (black arrow) at postoperative day 5 (B). Brain CT of postoperative one year (C) shows no residual shadow of hemorrhage.
jkss-21-183f3.tif
Table 1.
The reported cases of remote cerebellar hemorrhage complicated after lumbar spine surgery
Case Author (Year) Pathology Dura tear Clinical problem Treatment Outcome
1 Andrews et al.(1995) scoliosis Occult dural tear Deterioration in mental status EVD Quadraparetic
2 Gobel et al.(1999) Postdiscectomy syndrome Tear Headache, Lost consciousness Decompression+EVD D Recovery
3 Gobel et al.(1999) Spondylolisthesis Tear Headache, Lost consciousness EVD Residual disability
4 Friedman et al.(2002) Spondylolisthesis Occult dural tear Headache, vomiting, dysarthria, ataxia Dura repair Residual dysarthria
5 Thomas et al.(2002) Schwannoma Intradural manipu-lation Headache, nausea Conservative Recovery
6 Karaeminogullari et al.7) (2005) Spinal stenosis Tear Lost consciousness Decompression Mild ataxia
7 Farag et al.(2005) Spinal stenoss Occult dural tear Lost consciousness Decompression Recovery
8 Brockmann et al.5)(2005) Spondylolisthesis Tear EVD
9 Chalela et al.(2006) Spinal stenosis Tear
10 Konya et al.(2006) Herniated disc + spinal stenosis Tear Headache, vomiting, dysarthria Conservative Recovery
11 Calisaneller et al.(2007) Spondylolisthesis Tear Headache, nausea Conservative Recovery
12 Nam et al.4)(2009) Herniated disc + spinal stenosis Tear Headache, nausea, diminished consciousness Decompression+EVD D
13 Pallud et al.8)(2009) Spondylolisthesis Occult dural tear Headache, Lost consciousness EVD Recovery
14 Kim et al.(2010) Herniated disc + Spondylolisthesis Tear Headache, nausea, disoriented, dysarthria Decompression+EVD D Wheelchair ambu-lation
15 Fernandez et al.3)(2011) Spinal stenosis Tear Headache, vomiting, diminished consciousness Conservative Recovery
16 You et al.1)(2012) Herniated disc + Failed back syndrome Tear Postural headache, CSF leakage through surgical wound Dura repair Recovery
17 Khalatbari et al.2)(2012) Herniated disc Occult dural tear Headache, vomiting, lost consciousness EVD Recovery
18 Khalatbari et al.2)(2012) Spinal stenosis Dura tear Failure of anesthesia recovery Decompression Die
19 Yoo et al.(2013) Intradural mass Intradural manipu-lation Headache, nausea, vomiting, dizziness nystagmus Decompression Recovery
20 Current case Spondylolisthesis Tear Headache, vomiting Conservative Recovery

EVD: extraventricular drainage.

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