Remote Intracranial Hemorrhage after Spinal Surgery: Possible Etiology and Incidence

Toshimi Aizawa, Hiroshi Ozawa, Yoshihiro Ashina, Ko Hashimoto, Haruo Kanno,Toshimitsu Eto and EijiItoi

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Japan
Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Japan

^*Correspondance to: Toshimi Aizawa 

 PDF  Full Text DOI: 10.25107/2474-1647.2058

Abstract

Background: Remote Intracranial Hemorrhage (RIH) is a rare but potentially lethal complication related to Cerebro Spinal Fluid (CSF) drainage. Spinal surgery has a chance of durotomy or dural tear. However, the exact incidences of RIH resulting from spinal surgery remain uncertain.Objective: The aim of the present study was to prospectively evaluate the incidence of RIH, and the relationship between RIH and CSF drainage volume.
Methods: A total of 691 patients underwent spinal surgery in our department between May 2007 and April 2016. Among these, 175 had durotomy or dural tear, which were evaluated with brain CT the day after surgery, regardless of brain symptoms. The clinical features of RIH and drainage volume were assessed.Results: Three patients were affected by RIH, including two asymptomatic. The incidence among all spinal surgeries was 0.4% and among durotomy or dural tear was 1.7%. Patients with RIH had significantly more drainage totally and per 24 hours after surgery than those without (589 ± 157 ml vs. 314 ± 968 ml, p=0.01; 898 ± 185 ml vs.157 ± 160 ml, p=0.003). RIH was detected in the cerebellum alone, in both the cerebellum and cerebrum, and in the cerebrum alone in one each, respectively. One patient with hydrocephalus was treated conservatively and completely recovered from their brain symptoms within 17 days.
Conclusion: The incidence of RIH in this study was higher than expected. RIH was closely related to CSF drainage volume, in particular, with large volume loss within a short time.

Keywords

Remote Intracranial Hemorrhage; Spinal surgery; Prospective study; cerebrospinal fluid; complication

Cite the article

Aizawa T, Ozawa H, Ashina Y, Hashimoto K, Kanno H, Eto T, et al. Remote Intracranial Hemorrhage after Spinal Surgery: Possible Etiology and Incidence. Clin Surg. 2018; 3: 2058.