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Intracranial complications associated with spinal surgery

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Abstract

Purpose

Though rare, intracranial complications have been reported as a result from spinal surgery. Most if not all of these are a result of intracranial hypotension from durotomy and cerebrospinal fluid (CSF) leak. We aimed to characterize these complications across a large postoperative population at our institution.

Methods

We conducted a retrospective review of all patients who underwent spinal surgery at our institution by four neurosurgeons from July 2008 to August 2013.

Results

Our review yielded 1113 consecutive patients who underwent spinal surgery for a total of 1396 procedures. Intracranial imaging using either computed tomography or magnetic resonance imaging was obtained on 59 (4.2 %) patients after a procedure due to neurologic change. Six patients (0.4 %) were found to have intracranial findings of subdural hygroma (4 patients), remote cerebellar hemorrhage (1 patient), or subdural hematoma (1 patient).

Conclusion

Intracranial complications from spinal surgery are a rare event. We demonstrate an incidence of 0.4 % of total intracranial pathology after spinal surgery. A strong clinical suspicion must be maintained after durotomy or CSF leak due to these infrequent but potentially life-threatening complications.

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References

  1. Kraemer R, Wild A, Haak H, Herdmann J, Krauspe R, Kraemer J (2003) Classification and management of early complications in open lumbar microdiscectomy. Eur Spine J 12:239–246. doi:10.1007/s00586-002-0466-y

    PubMed  PubMed Central  Google Scholar 

  2. Beier AD, Soo TM, Claybrooks R (2009) Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J 9:e9–e12. doi:10.1016/j.spinee.2009.06.012

    Article  PubMed  Google Scholar 

  3. Lindley EM, McCullough MA, Burger EL, Brown CW, Patel VV (2011) Complications of axial lumbar interbody fusion. J Neurosurg Spine. doi:10.3171/2011.3.SPINE10373

    PubMed  Google Scholar 

  4. Parpaley Y, Urbach H, Kovacs A, Klehr M, Kristof RA (2011) Pseudohypoxic brain swelling (postoperative intracranial hypotension-associated venous congestion) after spinal surgery: report of 2 cases. Neurosurgery 68:E277–E283. doi:10.1227/NEU.0b013e3181fead14

    Article  PubMed  Google Scholar 

  5. Burkhard PR, Duff JM (2000) Bilateral subdural hematomas following routine lumbar diskectomy. Headache 40:480–482

    Article  CAS  PubMed  Google Scholar 

  6. Friedman JA, Ecker RD, Piepgras DG, Duke DA (2002) Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery 50:1361–1363 (discussion 1363–1364)

    PubMed  Google Scholar 

  7. Konya D, Ozgen S, Pamir MN (2006) Cerebellar hemorrhage after spinal surgery: case report and review of the literature. Eur Spine J 15:95–99. doi:10.1007/s00586-005-0987-2

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kuhn J, Hofmann B, Knitelius HO, Coenen HH, Bewermeyer H (2005) Bilateral subdural haematomata and lumbar pseudomeningocele due to a chronic leakage of liquor cerebrospinalis after a lumbar discectomy with the application of ADCON-L gel. J Neurol Neurosurg Psychiatry 76:1031–1033. doi:10.1136/jnnp.2004.046276

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Thomas G, Jayaram H, Cudlip S, Powell M (2002) Supratentorial and infratentorial intraparenchymal hemorrhage secondary to intracranial CSF hypotension following spinal surgery. Spine (Phila Pa 1976) 27:E410–E412

    Article  Google Scholar 

  10. Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 389:238–247

    Article  PubMed  Google Scholar 

  11. Lee KS, Hardy IM 2nd (1992) Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery 30:111–114

    Article  CAS  PubMed  Google Scholar 

  12. Gaucher DJ Jr, Perez JA Jr (2002) Subdural hematoma following lumbar puncture. Arch Intern Med 162:1904–1905

    Article  PubMed  Google Scholar 

  13. Sciubba DM, Kretzer RM, Wang PP (2005) Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery. Spine (Phila Pa 1976) 30:E730–E732

    Article  Google Scholar 

  14. Acharya R, Chhabra SS, Ratra M, Sehgal AD (2001) Cranial subdural haematoma after spinal anaesthesia. Br J Anaesth 86:893–895

    Article  CAS  PubMed  Google Scholar 

  15. Wells JB, Sampson IH (2002) Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report. Mt Sinai J Med 69:109–110

    PubMed  Google Scholar 

  16. Reina MA, Alvarez-Linera J, Lopez A, Benito-Leon J, De Andres JA, Sola RG (2002) Magnetic resonance in dural post-puncture headache in patient with cerebrospinal fluid hypotension. Rev Esp Anestesiol Reanim 49:89–100

    CAS  PubMed  Google Scholar 

  17. Garcia-Morales I, Porta-Etessam J, Galan L, Lagares A, Molina JA (2001) Recurrent subdural haematomas in a patient with spontaneous intracranial hypotension. Cephalalgia 21:703–705

    Article  CAS  PubMed  Google Scholar 

  18. Roll JD, Larson TC 3rd, Soriano MM (2003) Cerebral angiographic findings of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 24:707–708

    PubMed  Google Scholar 

  19. Fishman RA, Dillon WP (1993) Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 43:609–611

    Article  CAS  PubMed  Google Scholar 

  20. Schievink WI (2006) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:2286–2296. doi:10.1001/jama.295.19.2286

    Article  CAS  PubMed  Google Scholar 

  21. Ferrante E, Savino A, Sances G, Nappi G (2004) Spontaneous intracranial hypotension syndrome: report of twelve cases. Headache 44:615–622. doi:10.1111/j.1526-4610.2004.446012.x

    Article  PubMed  Google Scholar 

  22. Schievink WI, Meyer FB, Atkinson JL, Mokri B (1996) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84:598–605. doi:10.3171/jns.1996.84.4.0598

    Article  CAS  PubMed  Google Scholar 

  23. Lu CH, Ho ST, Kong SS, Cherng CH, Wong CS (2002) Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth 49:100–102. doi:10.1007/BF03020428

    Article  PubMed  Google Scholar 

  24. Dillon WP, Fishman RA (1998) Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 19:1001–1002

    CAS  PubMed  Google Scholar 

  25. de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CA (2003) Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 74:752–755

    Article  PubMed  PubMed Central  Google Scholar 

  26. Francia A, Parisi P, Vitale AM, Esposito V (2001) Life-threatening intracranial hypotension after diagnostic lumbar puncture. Neurol Sci 22:385–389. doi:10.1007/s100720100069

    Article  CAS  PubMed  Google Scholar 

  27. Riera Sagrera M, Bergada Garcia J (2008) Cerebellar hemorrhage after spinal surgery. Med Intensiva 32:54–55

    Article  CAS  PubMed  Google Scholar 

  28. Karaeminogullari O, Atalay B, Sahin O, Ozalay M, Demirors H, Tuncay C, Ozen O, Tandogan R (2005) Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review. Neurosurgery 57:E215 (discussion E215)

    PubMed  Google Scholar 

  29. Gobel F, Heidecke V, Hube R, Reichel H, Held A, Hein W (1999) Cerebellar hemorrhage as an early complication of spinal operations. 2. Case reports and review of the literature. Z Orthop Ihre Grenzgeb 137:371–375. doi:10.1055/s-2008-1039729

    Article  CAS  PubMed  Google Scholar 

  30. Cevik B, Kirbas I, Cakir B, Akin K, Teksam M (2009) Remote cerebellar hemorrhage after lumbar spinal surgery. Eur J Radiol 70:7–9. doi:10.1016/j.ejrad.2008.01.004

    Article  PubMed  Google Scholar 

  31. Andrews RT, Koci TM (1995) Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect. AJNR Am J Neuroradiol 16:1312–1315

    CAS  PubMed  Google Scholar 

  32. Chadduck WM (1981) Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery 9:185–189

    Article  CAS  PubMed  Google Scholar 

  33. Brockmann MA, Groden C (2006) Remote cerebellar hemorrhage: a review. Cerebellum 5:64–68. doi:10.1080/14734220500521032

    Article  PubMed  Google Scholar 

  34. Brockmann MA, Nowak G, Reusche E, Russlies M, Petersen D (2005) Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg 102:1159–1162. doi:10.3171/jns.2005.102.6.1159

    Article  PubMed  Google Scholar 

  35. Nam TK, Park SW, Min BK, Hwang SN (2009) Remote cerebellar hemorrhage after lumbar spinal surgery. J Korean Neurosurg Soc 46:501–504. doi:10.3340/jkns.2009.46.5.501

    Article  PubMed  PubMed Central  Google Scholar 

  36. Morofuji Y, Tsunoda K, Takeshita T, Hayashi K, Kitagawa N, Suyama K, Nagata I (2009) Remote cerebellar hemorrhage following thoracic spinal surgery. Neurol Med Chir (Tokyo) 49:117–119

    Article  Google Scholar 

  37. Fernandez-Jara J, Jorge-Blanco A, Carro-Martinez AI, Ferreiro-Arguelles C, Fernandez-Gallardo JM, Romero-Coronado J (2011) Remote cerebellar hemorrhage after lumbar spinal surgery. Emerg Radiol 18:177–180. doi:10.1007/s10140-010-0917-4

    Article  PubMed  Google Scholar 

  38. Calisaneller T, Yilmaz C, Ozger O, Caner H, Altinors N (2007) Remote cerebellar haemorrhage after spinal surgery. Can J Neurol Sci 34:483–484

    Article  PubMed  Google Scholar 

  39. Gul S, Kalayci M, Acikgoz B (2010) A rare complication of spinal surgery: cerebellar hemorrhage. Turk Neurosurg 20:413–417. doi:10.5137/1019-5149.JTN.2283-09.2

    PubMed  Google Scholar 

  40. Khalatbari MR, Khalatbari I, Moharamzad Y (2012) Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 21:2091–2096. doi:10.1007/s00586-012-2187-1

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90089, USA

    Martin H. Pham, Alexander Tuchman, Andrew Platt & Patrick C. Hsieh

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  1. Martin H. Pham
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  2. Alexander Tuchman
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Correspondence to Martin H. Pham.

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Pham, M.H., Tuchman, A., Platt, A. et al. Intracranial complications associated with spinal surgery. Eur Spine J 25, 888–894 (2016). https://doi.org/10.1007/s00586-015-4241-2

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