Intraventricular hemorrhage as complication after spinal surgery. Case report.

Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures. The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening. Non-specific symptoms make it difficult to identify the origin of intracranial hemorrhagic from other differential diagnoses. We present a patient with an impaired level of awareness and seizures who suffered a hemorrhage in the right ventricle with cerebral and cerebellar edema in the immediate postoperative period after spinal surgery.

Hemorragia intraventricular como complicación tras una cirugía espinal. Caso clínico / Intraventricular hemorrhage as complication after spinal surgery. Case report

La hemorragia intracraneal (HIC) remota es una rara pero temida complicación tras la cirugía espinal. La fisiopatología de este fenómeno se relaciona estrechamente con la pérdida de líquido cefalorraquídeo (LCR) tras una lesión dural incidental durante la cirugía espinal. La localización de la HIC remota más frecuente es la cerebelar, existiendo pocos casos publicados de hemorragia intraventricular. Su clínica está asociada a la hipotensión cerebral por disminución de LCR, destacando la cefalea, la disartria, la hemiparesia, el deterioro del nivel de conciencia y las convulsiones.El diagnóstico de una HIC remota tras una cirugía no craneal puede ser un reto para los anestesiólogos; esta enfermedad debería sospecharse ante un deterioro neurológico inmediato al despertar anestésico. La sintomatología inespecífica dificultará identificar el origen hemorrágico intracraneal frente a otros diagnósticos diferenciales.Exponemos el caso de un paciente con disminución del nivel de conciencia y convulsión que presentó una hemorragia intraventricular derecha con edema cerebral y cerebeloso en el postoperatorio inmediato de una cirugía espinal.(AU)

Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures.The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening. Non-specific symptoms make it difficult to identify the origin of intracranial hemorrhagic from other differential diagnoses.We present a patient with an impaired level of awareness and seizures who suffered a hemorrhage in the right ventricle with cerebral and cerebellar edema in the immediate postoperative period after spinal surgery.(AU)

Intraventricular hemorrhage as complication after spinal surgery. Case report. / Hemorragia intraventricular como complicación tras una cirugía espinal. Caso clínico.

Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures. The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening. Non-specific symptoms make it difficult to identify the origin of intracranial hemorrhagic from other differential diagnoses. We present a patient with an impaired level of awareness and seizures who suffered a hemorrhage in the right ventricle with cerebral and cerebellar edema in the immediate postoperative period after spinal surgery.

Hemorragia subaracnoidea posterior a descompresión Lumbar mínimamente invasiva. Presentación de un caso y revisión de la literatura / Subarachnoid hemorrhage after minimally invasive lumbar decompression. Case report and literature review

Introducción: Las lesiones durales son complicaciones frecuentes en la cirugía de columna. La fuga de liquidocefalorraquideo (LCR) puede originar hemorragia en todos los compartimientos del cerebro. La mayoría ocurre en venas ubicadas en región cerebelosa.Material y método: Se presenta un caso de hemorragia subaracnoidea posterior a una descompresión lumbar mínimamente invasiva asociada a desgarro dural. Resultados: Evoluciona en el postoperatorio con síntomas neurológicos de cefaleas y trastornos del sensorio por lo que se decide evaluarlo con estudios por imágenes vasculares cerebrales identificándose sangrado subaracnoideo.Discusión: El sitio más frecuente de hemorragia intracraneal posterior a una cirugía de columna es el cerebelo. El mecanismo de acción de este tipo de sangrados es desconocido y controversial, hay algunos reportes que sugieren que se trataría de un sangrado venoso. El síntoma más característico de este síndrome es la cefalea. Aunque se desconoce la etiología exacta, se postula que la pérdida de volumen de LCR causa una caída en la presión intracraneal, lo que lleva a un agrandamiento de los senos venosos durales que predisponen al paciente a un hematoma subdural espontáneoConclusión: La fuga de LCR, las alteraciones asociadas al edema cerebral en la hipotensión cerebral podría ser llave del mecanismo que desencadena una hemorragia subaracnoidea.

compartments of the brain. Most occur in veins located in the cerebellar region.Material and method: A case of subarachnoid hemorrhage after a minimally invasive lumbar decompression associated with dural tear is presented.Results: It evolves in the postoperative period with neurological symptoms of headaches and sensory disorders, so it is decided to evaluate it with studies by cerebral vascular images identifying subarachnoid bleeding.Discussion: The most frequent site of intracranial hemorrhage after spinal surgery is the cerebellum. The mechanism of action of this type of bleeding is unknown and controversial, there are some reports that suggest that it would be a venous bleeding. The most characteristic symptom of this syndrome is headache. Although the exact etiology is unknown, it is postulated that the loss of CSF volume causes a drop in intracranial pressure, which leads to an enlargement of the dural venous sinuses that predispose the patient to a spontaneous subdural hematomaConclusion: CSF leakage, alterations associated with cerebral edema in cerebral hypotension could be key to the mechanism that triggers a subarachnoid hemorrhage.

Intracraneal complications after raquis surgery. / Complicación intracraneal tras cirugía de raquis lumbar.

Intracraneal bleeding is a rare complication after raquis surgery. It is believed to occur as a drop in the intracraneal pressure after a loss of CSF secondary to an iatrogenic dural tear. We report a patient who after surgery for lumbar stenosis presented a subarachnoid haemorrhage, an intraparenchymal haematoma, and a subdural haematoma. To our knowledge, this is the first report in the literature with such complications after this type of surgery.

Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case and literature review.

UNLABELLED: Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. The incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown. CASE REPORT: The case is reported of a rare case of a 41 year old woman with diagnosis of L3-L4, L4-L5 disc disease and left disc herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. Twenty-four hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scans revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originated in the lumbar spinal canal. The patient was treated conservatively, with progressive neurological improvement after 72 hours, and clinical and radiological normalization after 7 days. DISCUSSION: Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during the operation. Most collections are small, behave benign, and respond to conservative therapy. In the present case, an inadvertent dural tear, produced a pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, as well as remedying the source of air to prevent unwanted morbidity and mortality.