Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy: report of three cases.
OBJECTIVE
We report three cases of cerebellar hemorrhage complicating supratentorial craniotomies for the treatment of epilepsy. In a literature review, we identified only four similar cases of cerebellar hemorrhage after temporal lobectomy for the treatment of epilepsy.
Three young and otherwise healthy patients underwent frontal, occipital, and temporal resections for the treatment of refractory epilepsy. The hemorrhage manifested as peduncular tremor, ataxia, and decerebrate posturing presenting early in the postoperative period. The diagnosis was established by computed tomography and/or magnetic resonance imaging. Benign outcomes were observed for all patients.


CONCLUSIONS
Based on the available data, it is our opinion that brain dislocation resulting from excessive intraoperative cerebrospinal fluid drainage is a possible mechanism for this rare complication of supratentorial craniotomy. The overdrainage seems to be less hazardous when the procedure is performed for the removal of space-occupying mass lesions. In contrast, the resection of nonexpanding tissues, such as in lobectomies for the treatment of epilepsy, may be an additional risk factor, because the incidence of this complication seems to be higher in these situations.
Epilepsy Program of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
E M
EM
Yacubian
M M
MM
de Andrade
C L
CL
Jorge
R M
RM
Valério
D000328:Adult; D002526:Cerebellar Diseases / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000175:diagnosis*; D002648:Child; D003399:Craniotomy; D017029:Epilepsy, Complex Partial / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed