Tadatsugu Morimoto1, Makoto Shiraki, Koji Otani, Motoki Sonohata, Masaaki Mawatari. 1. *Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan; and †Department of Orthopedic Surgery, Faculty of Medicine, Fukushima Medical University, School of Medicine, Fukushima, Japan.
Abstract
STUDY DESIGN: Case report. OBJECTIVE: To report a case of an acute supratentorial subdural hemorrhage (SDH) of a previous head injury site and cerebellar hemorrhage, after an incidental dural tear during spine surgery. SUMMARY OF BACKGROUND DATA: Intracranial hemorrhage, such as subdural, cerebellar, subarachnoid, and epidural hemorrhage after a dural tear during spinal surgery, is a rare and poorly recognized complication. Moreover, only 3 cases in patients with concurrent SDH and cerebellar hemorrhage have been described in the literature, and none of these reports demonstrated the bleeding point on the adhesion site of the dural at the regions of the previous head injury. METHODS: A case report and literature review are presented. RESULTS: A 46-year-old male underwent occipital cervical surgery for os odontoideum. Intraoperatively, a dural tear was noted and repaired, but he later developed postoperative disturbance of consciousness. A head computed tomographic scan revealed a supratentorial SDH and cerebellar hemorrhage. Evacuation of the supratentorial SDH was performed via craniotomy, and the bleeding point was revealed to be on the adhesion site of the dural where the patient had experienced a previous head injury. The patient made a full recovery. CONCLUSION: This report illustrates that cerebrospinal fluid leakage after a dural tear during spinal surgery may cause intracranial hemorrhage. A previous head trauma could be a risk factor for such hemorrhagic complications. Headache, nausea, and postoperative stupor after spinal surgery, especially after an accidental durotomy, should be considered possible indications of intracranial hemorrhage, and affected patients should be investigated with computed tomography or magnetic resonance imaging. LEVEL OF EVIDENCE: N/A.
STUDY DESIGN: Case report. OBJECTIVE: To report a case of an acute supratentorial subdural hemorrhage (SDH) of a previous head injury site and cerebellar hemorrhage, after an incidental dural tear during spine surgery. SUMMARY OF BACKGROUND DATA: Intracranial hemorrhage, such as subdural, cerebellar, subarachnoid, and epidural hemorrhage after a dural tear during spinal surgery, is a rare and poorly recognized complication. Moreover, only 3 cases in patients with concurrent SDH and cerebellar hemorrhage have been described in the literature, and none of these reports demonstrated the bleeding point on the adhesion site of the dural at the regions of the previous head injury. METHODS: A case report and literature review are presented. RESULTS: A 46-year-old male underwent occipital cervical surgery for os odontoideum. Intraoperatively, a dural tear was noted and repaired, but he later developed postoperative disturbance of consciousness. A head computed tomographic scan revealed a supratentorial SDH and cerebellar hemorrhage. Evacuation of the supratentorial SDH was performed via craniotomy, and the bleeding point was revealed to be on the adhesion site of the dural where the patient had experienced a previous head injury. The patient made a full recovery. CONCLUSION: This report illustrates that cerebrospinal fluid leakage after a dural tear during spinal surgery may cause intracranial hemorrhage. A previous head trauma could be a risk factor for such hemorrhagic complications. Headache, nausea, and postoperative stupor after spinal surgery, especially after an accidental durotomy, should be considered possible indications of intracranial hemorrhage, and affected patients should be investigated with computed tomography or magnetic resonance imaging. LEVEL OF EVIDENCE: N/A.