Nam Taek Kyun, Park Seung Won, Min Byung Kook, Hwang Sung Nam
Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2009 Nov;46(5):501-4. doi: 10.3340/jkns.2009.46.5.501. Epub 2009 Nov 30.
Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.
远隔性小脑出血（RCH）虽罕见，但作为脊柱手术的并发症却有潜在致命性。我们最近遇到一例61岁男性的RCH病例，该患者在腰椎手术后出现精神衰退。手术过程中存在硬脊膜撕裂并随后出现脑脊液（CSF）流失。脑部计算机断层扫描显示小脑出血、第三和第四脑室出血以及气颅。他接受了枕下颅骨切除术和血肿清除术。已知脊柱手术后导致RCH的最重要病理机制是由于大量CSF快速渗漏导致小脑尾侧下垂引起的静脉出血，这似乎与该病例有关。术中硬脊膜撕裂后进行硬脊膜修复并尽量减少CSF流失，将有助于预防术后RCH。
