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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Supra- and infratentorial hemorrhage as a consequence of loss of cerebrospinal fluid after surgery – two case reports

Meeting Abstract

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  • Viet Phuong Tran - Klinik für Neurochirurgie, Klinikum Nordstadt, Klinikum Region Hannover, Deutschland
  • Ralf Burger - Klinik für Neurochirurgie, Klinikum Nordstadt, Klinikum Region Hannover, Deutschland
  • Ralf Ullrich Stiller - Klinik für Neurochirurgie, Klinikum Nordstadt, Klinikum Region Hannover, Deutschland
  • Micheal R. Gaab - Klinik für Neurochirurgie, Klinikum Nordstadt, Klinikum Region Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1824

DOI: 10.3205/10dgnc295, URN: urn:nbn:de:0183-10dgnc2956

Published: September 16, 2010

© 2010 Tran et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Illustration of two rare cases with supra- and infratentorial hemorrhage as a consequence of an accelerated loss of cerebrospinal fluid.

Methods: Both pts. were admitted to our hospital for neurosurgical intervention. One pat. (88 yrs., female, case 1) suffered from a right-sided space-occupying chronic subdural hematoma (cSDH), the other from degenerative spondylolisthesis (74 yrs., female, case 2). Clinical history, radiological and surgical interventions are demonstrated and the possible pathophysiological mechanism presented.

Results: In the first case the subdural drainage accidentally disconnected day 2 after evacuation of cSDH and loss of CSF occured. Pat. developed within hrs. a neurological deterioration with aphasia and loss of consciousness. CCT scan showed a hydrocephalus and subarachnoid hemorrhage (SAH) over both cerebellar hemispheres. An external ventricular drainage was inserted and pat. was dismissed to rehabilitation with ataxia, dysarthria and spatial orientation. In the second case primary surgery with PLIF and dorsal instrumentation was uneventful. Immediately post surgery the pat. developed uncommon blood loss over the wound drainages and arterial hypotension. CT's of abdomen/lumbar spine excluded any vascular lesions or misplacement of the implants. CCT scan showed atypical frontal intracerebral hemorrhages, a severe SAH and a generalized brain edema, especially involving the infratentorial space. A CSF leakage could not be ruled out since the drainage fluid looked suspiciously light in time course. Acute operative revision confirmed an unrecognized CSF leakage which was repaired. The pat. additionally received an external ventricular drainage Pat. received long term ICU treatment and was dismissed for rehabilitation with GOS of 3.

Conclusions: Acute loss of CSF generates a differential force on CSF which may influence the venous drainage. The velocity of CSF loss and the differential force may be proportional related. In rare conditions this may lead to intracerebral hemorrhage mainly in posterior fossa / cerebellum and to venous SAH.