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Updated: Feb 26, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Supratentorial acute subdural haematoma during microvascular decompression surgery: report of three cases
Kenichi Amagasaki1, Yutaka Takusagawa2, Kyoko Kanehashi1
1Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
Abstract:
Supratentoiral haemorrhage during posterior fossa surgery is very rare. Authors report three cases of acute subdural haematoma occurred during microvascular decompression (MVD). Bleeding was observed in the suboccipital surgical area during operation but the origin of the bleeding was not confirmed intraoperatively in all cases. Decompression procedure was completed and immediate postoperative computed tomography revealed supratentorial subdural haematoma. This complication was observed during MVD in healthy young patients with hemifacial spasm in our cases. Flexion of the head with reduction of cerebrospinal fluid may have induced rotational movement of the cerebrum resulting in rupture of bridging veins, but no definitive mechanism that fulfils the clinical characteristics was clearly determined.
Insights
Supratentorial subdural hematomas are a rare complication of posterior fossa surgery, specifically microvascular decompression (MVD). This study details three cases in young patients, highlighting a potential link between head positioning and cerebral venous injury.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Posterior fossa surgery, particularly microvascular decompression (MVD), is a standard treatment for conditions like hemifacial spasm.
- Supratentorial hemorrhages are exceptionally uncommon during these procedures, which are typically focused on the posterior cranial fossa.
Observation:
- Three cases of acute subdural hematoma (SDH) occurring during MVD are presented.
- Intraoperative bleeding in the suboccipital region was noted, but its source remained unclear in all instances.
- The MVD procedure was completed, with postoperative CT scans confirming supratentorial SDH.
Findings:
- The complication occurred in young, otherwise healthy patients undergoing MVD for hemifacial spasm.
- A potential mechanism involves head flexion reducing cerebrospinal fluid, causing cerebral rotation and bridging vein rupture.
- However, a definitive cause for this specific clinical presentation was not established.
Implications:
- This rare complication warrants consideration in the differential diagnosis of postoperative neurological deficits after posterior fossa surgery.
- Further research may be needed to elucidate the precise biomechanical factors contributing to supratentorial hemorrhages during MVD.
- Understanding this complication could inform surgical technique modifications to mitigate risk.
