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Remote Cerebellar Hemorrhage Complicating Unintended Durotomy in Lumbar Spine Surgery

Yizhar Floman, MD, Michael A Millgram, MD, Ely Ashkenazi, MD, Nahshon Rand, MD

Israel Spine Center at Assuta Hospital, Tel Aviv, Israel

Abstract

Study design

Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years.

Objectives

To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage.

Summary and background data

Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH).

Methods

During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. 

Results

Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients.

Conclusions

Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery.

keywords: 
incidental durotomy, lumbar surgery, CSF loss, cerebellar hemorrhage
Volume 9 Article 29
doi: 
10.14444/2029