Spinal subdural haematoma as a complication of cranial surgery.

BACKGROUND

Spinal subdural haematoma is a rare condition usually associated with several precipitating factors including coagulopathy, lumbar puncture, trauma, vascular malformation and previous spinal surgery. In this paper we report spinal subdural haematoma related to cranial surgery which is a previously unknown precipitating factor.

METHODS

The medical records of six patients in whom spinal subdural haematoma developed after cranial surgery was reviewed retrospectively for clinical presentation, radiological findings, treatment, and outcome.

FINDINGS

Six patients presented with low back pain and radiculopathy in the lower extremity after surgery for intracranial lesions. Symptom onset was between 2 and 9 days after cranial surgery. Initial cranial procedures were craniotomy and tumour removal in 1 patient, clipping of aneurysm in 1, temporal lobectomy for epilepsy in 4. None of the patients had previously known precipitating factors for spinal subdural haematoma. In all of them, the diagnosis was confirmed by magnetic resonance (MR) imaging and the spinal segment involved was the lower lumbar and sacral level except for one patient with a wide distribution of haematoma over the thoracolumbar region. All patients recovered completely without surgical intervention.

INTERPRETATION

Spinal subdural haematoma is a rare but possible complication of cranial surgery. It should be considered in patients with back pain and radiculopathy in the lower extremity developing after surgery for intracranial lesions. Unlike spontaneous spinal subdural haematoma with other precipitating factors, spinal subdural haematoma developing after cranial surgery takes a benign clinical course and resolves spontaneously over several days to 2 weeks without surgical intervention.