Intracranial subdural hematoma and pneumocephalus after spinal instrumentation of myelodysplastic scoliosis.

To report a case of acute intracranial subdural hematoma, pneumocephalus, and pneumorachis, which occurred because of cerebrospinal fluid (CSF) leak caused by a malpositioned transpedicular screw during spinal surgery for severe myelodysplastic scoliosis accompanied with hydrocephalus. Intracranial hemorrhage may occur as a consequence of dural sac penetration and CSF leakage after various medical procedures at the spinal level. The awareness of this severe complication is especially important during spinal instrumentation procedures in which inadvertent dural sac violation and CSF loss may be overlooked. A case report and literature review are presented here. A 12-year-old girl with a history of myelomeningocele and hydrocephalus underwent instrumentation for severe myelodysplastic scoliosis. Postoperatively, she became aphasic and increasingly somnolent. An urgent computed tomographic scan of the head and spine showed massive intracranial hematoma, pneumocephalus, pneumorachis, and a malpositioned pedicular screw that caused CSF leakage, intracranial hypotension, and bleeding remote from the surgical site. The patient needed neurosurgical cranial decompression and subsequent spinal reoperation with dural tear repair. The final outcome was an uneventful complete recovery. The increasing use of pedicular screws in spinal surgery carries a potential risk of occult dural sac violation with subsequent CSF leakage, intracranial hypotension, and the possibility of intracranial bleeding and pneumocephalus remote from the surgical site. This potentially fatal complication should always be considered after spinal surgery in the presence of early signs of neurological deterioration and necessitates an urgent cranial and spinal imaging to confirm the diagnosis and to make adequate treatment decisions.

Hematoma in the splenium of the corpus callosum in the subacute stage of subarachnoid hemorrhage--three case reports.

Three patients developed hemorrhage in the splenium of the corpus callosum 2 weeks after the onset of subarachnoid hemorrhage (SAH) associated with acute hydrocephalus. Computed tomography performed a few days after the onset showed a low density area in the splenium of corpus callosum in all three patients, and preventive measures against symptomatic vasospasm were begun, including vasodilator administration. Computed tomography showed hemorrhage in the splenium of the corpus callosum 17 to 22 days after onset of SAH, manifesting as mental deterioration or headache. Antivasospasm agents were immediately discontinued, and strict blood control measures were instituted. Splenial hematoma is another potential cause of neurological deterioration after surgery for SAH, in addition to vasospasm, hydrocephalus, and rebleeding.