CEREBELLAR HEMORRHAGIC INFARCTION AFTER PTERIONAL CRANIOTOMY: ANALYSIS OF PATHOGENETICAL MECHANISMS

Yıl 2003, Cilt: 16 Sayı: 1, 12 - 15, 03.12.2016

Deniz Konya Selçuk Peker Fatih Bayraklı İlhan Elmacı Necmettin Pamir

Öz

Objectives: Cerebellar venous infarction after supratentorial craniotomy has emerged as an infrequent, however, important and preventable problem in the recent literature. Cerebellar hemorrhage is secondary to venous infarction, however, exact pathogenetical mechanisms have not been demonstrated. In this study we evaluate possible etiological factors in 5 cases of cerebellar infarction and discuss them in the light of the recent literature.
Methods: This is a retrospective series analysis of 5 cases of cerebellar infarction. For each case several preoperative factors, treatment methods and outcomes were evaluated and discussed.
Results: No etiological factors common to all cases were found in our analysis except for the type of craniotomy and use of postoperative drains. However, no causative relationship could be established for either of these. For pterional craniotomy patients positioning and excessive CSF drainage may be suspected. Early and late outcome after treatment was good for all cases. Two cases required surgical treatment for cerebellar hemorrhagic infarction and related complications.
Conclusions: Peroperative and postoperative excessive cerebrospinal fluid drainage and the
position of the patient leading to hyperextension of the neck during surgery are the most important factors in the etiology.
Key Words: Cerebellum, Complication, Hemorrhagic infarction, Supratentorial craniotomy

Kaynakça

• Brisman NH, Bederson JB, Sen CN, Qermano IN, Noore F, Post KD. Intracerebral hemorrhage occuring remote from the craniotomy site. Neurosurgery 1996/39:1 114-1122.
• Kalfas ifl, Little JR. Postoperative hemorrhage: A survey of 4992 intracranial procedures. Neurosurgery 1988/23:343-347.
• Kuroda R, Nakatani J, Akai F, et al. Remote subarachnoid haemorrhage in the posterior fossa following supratentorial surgery. Acta Neurochir 1994/129:158-165.
• Papanastassiou V, Herr R, Adams C. Contralateral cerebellar hemorrhagic infarction after pterional craniotomy: Report of five cases and review of the literature. Neurosurgery 1996/39:841-852.
• Seoane E, Rhoton AL. Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 1999/51:500-505.
• Toczek NT, Norrell NJ, Silverberg GA, Lowe GN. Cerebellar hemorrhage complicating temporal lobectomy. J Neurosurg 1996/85:718-722.
• Yacubian EN, deAndrade NN, Jorge CL, Valerio RN. Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy: Report of three cases. Neurosurgery 1999/45:159-162.
• Waga S, Shimosaka S, Sakakura N. Intracerebral hemorrhage remote from the site of the initial neurosurgical procedure. Neurosurgery 1983/13:662-665.
• Yoshida S. Cerebellar hemorrhage after supratentorial craniotomy- report of three cases. Neurol Ned Chir 1990/30:738-743.
• König A. Postoperative hemorrhage (Letter). J Neurosurg 1997/86:916-91 7.