Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

Remote Cerebellar Hemorrhage After Supratentorial Aneurysm Surgery: Report of 2 Cases / 대한뇌혈관외과학회지

Remote cerebellar hemorrhage is a rare complication of supratentorial neurosurgical surgery occurring in approximately 0.3~0.6%, and it is same with the supratentorial aneurysm surgery. Although remote cerebellar hemorrhage is a rare complication of supratentorial neurosurgical surgery, this is often related with significant morbidity and mortality. In spite of its lethal character, the precise mechanism is uncertain. In this article, we present clinical details of two patients with cerebellar hemorrhage after supratentorial aneurysm surgery, and discuss about possible mechanism of this rare complication. In reported articles, seven predisposing factors are correlated with remote cerebellar hemorrhage after supratentorial aneurysm surgery; hypertension, cerebrovasular anomaly, anti-coagulation treatment, coagulopathy, head positioning during surgery, over drainage via epidural closed drainage system with negative pressure, and excessive CSF drainage during or after the surgery. By reporting these two cases, we want to alert neurosurgeons about this rare but lethal complication, and tell about that there are several ways to minimize the possibility of remote cerebellar hemorrhage.