title: Remote cerebellar hemorrhage after supratentorial surgery.
abstract: OBJECTIVE
  Remote cerebellar hemorrhage (RCH) is an infrequent and poorly understood complication of supratentorial neurosurgical procedures. We retrospectively compared 42 patients who experienced RCH with a case-matched control cohort, to delineate risk factors associated with the occurrence of this complication.
  
  
  METHODS
  Between 1988 and 2000, 42 patients experienced RCH after supratentorial neurosurgical procedures at our institution. Diagnoses were made on the basis of postoperative computed tomographic or magnetic resonance imaging findings in all cases. The medical records for these patients were reviewed and compared with those for a control cohort of 43 patients, matched for age, sex, surgical lesion, and type of craniotomy, who were treated during the same period.
  
  
  RESULTS
  RCH most commonly occurred after frontotemporal craniotomies for unruptured aneurysm repair or temporal lobectomy and was frequently an incidental finding on postoperative computed tomographic scans. However, some cases of RCH were associated with significant morbidity, and two patients died. Preoperative aspirin use and elevated intraoperative systolic blood pressure were significantly associated with RCH (P = 0.026 and P = 0.036, respectively). Pathological findings for two cases demonstrated hemorrhagic infarctions in both.
  
  
  CONCLUSIONS
  RCH most commonly follows supratentorial neurosurgical procedures, performed with the patient in the supine position, that involve opening of cerebrospinal fluid cisterns or the ventricular system (such as unruptured aneurysm repair or temporal lobectomy). Preoperative aspirin use and moderately elevated intraoperative systolic blood pressure are potentially modifiable risk factors associated with the development of RCH. Although RCH can cause death or major morbidity, most cases are asymptomatic or exhibit a benign course. Cerebellar "sag" as a result of cerebrospinal fluid hypovolemia, causing transient occlusion of superior bridging veins within the posterior fossa and consequent hemorrhagic venous infarction, is the most likely pathophysiological cause of RCH.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. friedman.jonathan@mayo.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Friedman
authors.forename: D G
authors.initials: DG
authors.lastname: Piepgras
authors.forename: D A
authors.initials: DA
authors.lastname: Duke
authors.forename: R L
authors.initials: RL
authors.lastname: McClelland
authors.forename: P S
authors.initials: PS
authors.lastname: Bechtle
authors.forename: C O
authors.initials: CO
authors.lastname: Maher
authors.forename: A
authors.initials: A
authors.lastname: Morita
authors.forename: W J
authors.initials: WJ
authors.lastname: Perkins
authors.forename: J E
authors.initials: JE
authors.lastname: Parisi
authors.forename: R D
authors.initials: RD
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015173:Supratentorial Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed