Remote cerebellar hemorrhage following supratentorial craniotomy.
OBJECTIVE
Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedure. The exact pathophysiology of this type of hemorrhage is poorly understood. We retrospectively compared 16 patients who had remote cerebellar hemorrhage (RCH) with a case-matched  control cohort, to determine the significance of perisurgical and surgical factors that may predispose patients to such bleeding events.


METHODS
From 1 June 2005 to 31 December 2008, postoperative routine head computed tomographic (CT) scan was performed in our institution and 16  patients with RCH after supratentorial neurosurgical procedure were identified. The medical charts of these 16 cases and a control cohort of 64 patients were recorded. All parameters were analyzed with regards to various variables.


RESULTS
The incidence RCH after supratentorial  craniotomy increased after postoperative computed tomographic scan. The mechanism of cerebellar hemorrhage in this series of patients is most likely multifactorial. Several variables showed a significant association with the occurrence of RCH. Multivariate analysis indicated that the following  two factors independently correlated with occurrence of RCH: (1) postoperative epidural drainage amount; and (2) history of previous cerebrovascular accident (CVA) with cerebral atrophy. All cases with RCH underwent medical treatment and no neurological sequelae associated with RCH.


CONCLUSIONS
Postoperative epidural drainage amount and history of previous CVA with cerebral atrophy can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy. One of the most important strategies to minimize hazardous complications is to be aware of these potential  risk factors and to take action to prevent them.
National Cheng-Kung University Medical Center and Medical School, Tainan, Taiwan.
Chih-Yuan
CY
Huang
Po-Hsuan
PH
Lee
Sheng-Hsiang
SH
Lin
Ming-Tsung
MT
Chuang
Yuan-Ting
YT
Sun
Yu-Chang
YC
Hung
E-Jian
EJ
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed