title: Intracranial hemorrhage after spine surgery.
abstract: OBJECTIVE
  The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome.
  
  
  METHODS
  The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery.
  
  
  RESULTS
  The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period.
  
  
  CONCLUSIONS
  Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome.
authors.affiliation: Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA. paulkaloostian@hotmail.com
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kaloostian
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Kim
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000601:surgery; D007431:Intraoperative Complications / Q000134:cerebrospinal fluid / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000134:cerebrospinal fluid / Q000601:surgery; D016896:Treatment Outcome