J Korean Soc Spine Surg.  2014 Dec;21(4):183-188. 10.4184/jkss.2014.21.4.183.

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

• Choi BW
• Lee SM
• Yoon MG
• Moon MS

• KMID: 2097870
• DOI: http://doi.org/10.4184/jkss.2014.21.4.183

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.

Keyword

Cerebellar Hemorrhage; CSF; Dura; tear; Lumbar vertebrae

MeSH Terms

Blood Pressure
Brain
Consciousness
Constriction
Decompression*
Dopamine
Drainage
Early Diagnosis
Female
Headache
Hemorrhage*
Humans
Hypotension
Lumbar Vertebrae
Middle Aged
Nausea
Postoperative Nausea and Vomiting
Spinal Stenosis
Wounds and Injuries
Dopamine

Figure

• 

  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.

• 

  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.

• 

  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.

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