Cerebellar Hemorrhage and Spinal Fluid Overdrainage With Tonsillar Herniation Following Spine Surgery.

Sudhakar Kinthala,Christopher G Paramore,Abistanand Ankam,Kuiran Jiao

doi:10.7759/cureus.10418

Abstract

Spinal fluid overdrainage with cerebellar hemorrhage is a rare complication of spinal surgery that can have severe consequences if not detected quickly. We present the case of a 72-year-old Caucasian female who underwent thoracolumbar fixation for flatback syndrome. Intraoperatively, the patient suffered a dural injury that was repaired. In the immediate postoperative period, the patient’s neurological status rapidly deteriorated within an hour and Jackson-Pratt (JP) drain output measured 300 ml of serosanguinous fluid. A stat CT scan revealed cerebellar hemorrhage, pneumocephalus, and tonsillar herniation. The postoperative drain was immediately removed, and a ventriculostomy tube was placed, confirming low intracranial pressure. Postoperatively, the patient was electively ventilated for three days, continued with remote cerebellar hemorrhage (RCH) treatment and precaution, and extubated on the third day as the patient’s neurological function continued to improve. The patient was discharged home nine days after the initial surgery, with a complete recovery. This case indicates that wound drainage in the face of durotomy can induce cerebellar herniation as early as within an hour postoperatively following spine surgery with a dural tear, even after dural repair. This case also suggests that early recognition and appropriate management of RCH is the key to a full recovery. Even in the event of tonsillar herniation and cerebellar hemorrhage, a complete recovery is possible with early recognition and proper management.

Highlights

Tonsillar herniation associated with remote cerebellar hemorrhage (RCH), which develops distant to the site of surgery, is a rare but potentially lethal complication of supratentorial craniotomy or spinal surgery [1]
Overdrainange of spinal fluid associated with tonsillar herniation and cerebellar hemorrhage is a potentially lethal complication of supratentorial craniotomy and spinal surgery [11], Sturiale et al reviewed 57 cases of RCH and found that intraoperative dural lesions were described in approximately 93% of patients
Wound drainage in patients following spine surgery should be curtailed in the presence of a dural tear, even if the repair is deemed watertight

Summary

Introduction

Tonsillar herniation associated with remote cerebellar hemorrhage (RCH), which develops distant to the site of surgery, is a rare but potentially lethal complication of supratentorial craniotomy or spinal surgery [1]. Floman et al observed an incidence rate of 0.26% for RCH in their study of 210 patients who had CSF loss following lumbar spine surgery [4]. To the best of our knowledge, this is the first case where the patient developed cerebellar herniation, associated with RCH and pneumocephalus in the first hour following spine surgery. How to cite this article Kinthala S, Jiao K, Ankam A, et al (September 13, 2020) Cerebellar Hemorrhage and Spinal Fluid Overdrainage With Tonsillar Herniation Following Spine Surgery. On the first postoperative day, the patient was still intubated and unarousable She was breathing spontaneously, able to move the right upper and both lower extremities randomly, but her eyes were still rolling downwards. At a follow-up visit one month, the patient was doing well, having an excellent functional and neurological status, with no residual complication

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Disclosures

Chadduck WM