Abstract
IntroductionMicrovascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, and other cranial nerve rhizopathies. However, critical complications still exist, and postoperative hemorrhage is one of the most life threatening complications following microvascular decompression. Most of the hemorrhages occur in the infratentorial region, and we found only four reports of supratentorial acute hemorrhages following microvascular decompression. Here, we report four cases of such hematomas and discuss the potential underlying mechanisms. Moreover, we discuss methods for handling such complications.Case descriptionBetween 2004 and 2015, four patients developed postoperative hemorrhages, all of which were supratentorial subdural hematomas. The hematomas occurred ipsilaterally in two cases and contralaterally in two cases. All of the patients were treated conservatively and discharged without clinical symptoms.Discussion and evaluationAlthough several intracranial hematomas have been reported distant from the craniotomy site, few reports of remote subdural hematomas after microvascular decompression exist. Draining large amounts of intraoperative cerebrospinal fluid may induce brain shifts and tearing of the small bridging veins. Of our four cases, two were ipsilateral and two were contralateral, and the side of the hemorrhage may suggest possible mechanisms of remote subdural hematomas in microvascular decompression. Although a lateral position for microvascular decompression mainly extends ipsilateral bridging veins, a postoperative supine position can extend bilateral veins equally. Therefore, we assumed that, supratentorial subdural hematomas occurred when the patients were returned to the supine position at the end of the microvascular decompression surgery. We may be able to prevent supratentorial subdural hematomas with the application of sufficient amounts of artificial cerebrospinal fluid immediately after a microvascular decompression.ConclusionWe suggest that it is important to avoid excessive CSF aspiration and to compensate for the cerebrospinal fluid loss with artificial cerebrospinal fluid adequately in order to avoid subdural hematomas after microvascular decompression. In addition, immediate postoperative CT scan is recommended even if the MVD has performed uneventfully.
Highlights
Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, and other cranial nerve rhizopathies
We suggest that it is important to avoid excessive CSF aspiration and to compensate for the cerebrospi‐ nal fluid loss with artificial cerebrospinal fluid adequately in order to avoid subdural hematomas after microvascular decompression
Most of the hemorrhages occur in the infratentorial region (McLaughlin et al 1999), and we found only four reports of supratentorial acute hemorrhages following Microvascular decompression (MVD) (Barker et al 1996; Hanakita and Kondo 1988; Li et al 2007; Oh et al 2008)
Summary
We describe four cases of supratentorial acute SDHs after MVD that were remote from the site of surgery. The hemorrhagic complications of posterior cranial fossa surgery described them insufficiently or with sites in the infratentorial region (Barker et al 1996; Dubey et al 2009; Kalkanis et al 2003; McLaughlin et al 1999) Two of these reports included one supratentorial SDH (Barker et al 1996; Oh et al 2008), but neither described the clinical details of the SDHs. Several recent cases of postsurgical remote hematomas, including cerebellar hemorrhage after supratentorial craniotomies (Figueiredo et al 2009; Li et al 2013) and supratentorial SDH after spinal surgeries (Nowak et al 2011; Takahashi et al 2012), have been reported. Even if the surgery was performed uneventfully, immediate postoperative CT scan should be performed routinely
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