title: Intracranial hemorrhage following lumbar spine surgery.
abstract: BACKGROUND
  Intracranial hemorrhage is a serious but rare complication of spinal surgery, which can occur in the intracerebral, cerebellar, epidural, or subdural compartment.
  
  
  OBJECTIVE
  To describe patients with intracranial hemorrhage after lumbar spinal surgery and present clinical and diagnostic imaging findings.
  
  
  METHODS
  In this retrospective study, medical records of 1,077 patients who underwent lumbar spinal surgery in our tertiary referral neurosurgery center between January 2003 and September 2010 were studied. The original presentations of the patients before the surgical intervention were herniated lumbar disc, spinal canal stenosis, spondylolisthesis, lumbar spinal trauma, and lumbar spine and epidural tumor. The operations performed consisted of discectomy, multiple level laminectomy, stabilization and fusion, lumbar instrumentation, and lumbar spinal and epidural tumor resection.
  
  
  RESULTS
  Four cases developed intracranial hemorrhage including acute subdural hematoma (one case), epidural hematoma (one case), and remote cerebellar hemorrhage (two cases). The clinical and diagnostic imaging characteristics along with treatments performed and outcomes of these four patients are described and the pertinent literature regarding post-lumbar spinal surgery intracranial hemorrhages is reviewed.
  
  
  CONCLUSIONS
  Though rare, intracranial hemorrhage can occur following lumbar spinal surgery. This complication may be asymptomatic or manifest with intense headache at early stages any time during the first week after surgery. Dural tear, bloody CSF leakage, focal neurologic symptoms, and headache are indicators of potential intracranial hemorrhage, which should be considered during or following surgery and necessitate diagnostic imaging.
authors.affiliation: Department of Neurosurgery, Arad Hospital, Somayeh St., Dr. Shariati and Bahar Ave., Tehran, Iran. mrkhalatbari@hotmail.com
authors.forename: Mahmoud Reza
authors.initials: MR
authors.lastname: Khalatbari
authors.forename: Iraj
authors.initials: I
authors.lastname: Khalatbari
authors.forename: Yashar
authors.initials: Y
authors.lastname: Moharamzad
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery