gms | German Medical Science

Objective: Intracranial complications after spinal surgery are rare but potentially life-threatening. Beside intracranial haemorrhage (ICH) and subdural effusion, both due to a significant loss of cerebrospinal fluid (CSF), cerebral ischemia may complicate the postoperative course after spinal surgery.

Methods: Retrospective study of cases with intracranial complications after spinal surgery treated in our institution between January 2012 and December 2018 with analysis of demographic, clinical, radiographic, treatment and outcome data.

Results: Our investigation revealed 23 patients with cerebral ischemia, 10 patients with ICH and 2 with subdural effusion. Incidence of stroke and ICH after spinal surgery was 0.26% and 0.0657% respectively. The mean age of the 21 female and 14 male patients was 69 years. A CSF-loss was evident in all cases of ICH or subdural effusion and 17% of cerebral ischemia. 80% of patients with bleeding and 78% with ischemia suffered from arterial hypertension. In 6 patients out of the ischemic population a history of stroke or TIA was described while 5 had a history of cancer. 74% of the strokes where located in the territory of the middle cerebral artery. Inthe ICH-group, 6 patients were treated conservatively while 3 required CSF-diversion measure and in 3 cases lumbar revision was necessary. In the ischemia-group rT-PA was used in one case locally and in one patient systemically, a thrombectomy was performed in another. Out of the ICH-group 8 patients could be discharged with mild or no neurologic symptoms, 3 patients suffered from significant deterioration while one patient died due to symptoms of brain stem compression. In the ischemia-group 14 patients showed complete recovery, in 5 cases significant dificits persisted whereas 4 patients died

Conclusion: Despite a very low complication rate, due to the large number of operated cases, we were able to present one of the largest series in the literature. It can be supposed that intracranial hypovolemia due to a significant CSF-loss may induce brain sagging which may promote ICH due to stretching of cortical bridging veins. After intentionally or inadvertently opening of the dura a watertight closure should be attempted. Patients with intraoperative CSF-loss should be under closely supervision in the postoperative course. ICH or cerebral ischemia must be considered in every patient with neurological deterioration after spinal surgery. A high index of suspicion is mandatory for early recognition and to prevent fatal outcome.