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Intracerebral hemorrhage occurring remote from the craniotomy site
M H Brisman1, J B Bederson, C N Sen
1Department of Neurosurgery, Mount Sinai Medical Center, New York, New York, USA.
Neurosurgery
|December 1, 1996
Summary
Remote intracerebral hemorrhage is a rare but serious complication following craniotomy. These hemorrhages, occurring away from the surgical site, are associated with significant disability and death.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Medicine
Background:
- Postoperative intracerebral hemorrhage (ICH) remote from the craniotomy site is a rare but significant complication.
- Understanding the characteristics and risk factors of remote ICH is crucial for improving patient outcomes.
Observation:
- Reviewed 37 cases of remote postoperative ICH (5 from own records, 32 from literature).
- Remote ICH occurred within hours postoperatively in 78% of cases.
- Specific craniotomy locations and patient positioning (sitting) were associated with particular patterns of remote ICH.
Findings:
- Remote ICH was not linked to lesion type, hypertension, coagulopathy, CSF drainage, or occult lesions.
- Supratentorial procedures often led to infratentorial hemorrhages (sylvian fissure, paraclinoid region), and infratentorial procedures (sitting position) led to supratentorial hemorrhages.
- Remote hemorrhages were superficial and lobar, differing from typical hypertensive locations.
Implications:
- Remote ICH is a rare complication with high morbidity (14% severe disability) and mortality (32% death).
- Hemorrhage development is likely early, linked to surgical factors, positioning, and mechanical influences.
- These findings highlight the need for vigilance and further research into the pathogenesis and prevention of remote ICH.