Sasani Mehdi, Sasani Hadi, Ozer Ali F
Neurosurgery Department, VKF: American Hospital, Istanbul, Turkey.
J Spinal Cord Med. 2010;33(1):77-9. doi: 10.1080/10790268.2010.11689678.
BACKGROUND/OBJECTIVE: Cerebellar hemorrhage is a very infrequent and unpredictable complication of spinal surgery. To the best of our knowledge, cerebellar hemorrhage resulting from the insertion of a lumbo-peritoneal shunt through which cerebrospinal fluid (CSF) is slowly drained has not been documented to date.
Case report.
A 47-year-old woman presented with lower extremity weakness. Spinal arteriovenous malformation was diagnosed, and she underwent surgery. Her neurologic status improved; however, CSF collected subcutaneously as a cyst and leaked 21 days after surgery. The patient underwent urgent surgery during which the dural defect was repaired and a lumbo-peritoneal catheter was put in place to treat the CSF leakage. The lumbo-peritoneal drainage system was removed when bilateral cerebellar hemorrhage was seen 12 days later. Physical therapy was stopped, and conservative treatment was initiated consisting of bed rest, analgesics, sedatives, and careful monitoring of blood pressure. The patient's headache gradually resolved; physical therapy was restarted to rehabilitate this patient with paraparesis.
Remote cerebellar hemorrhage seems to be life threatening and entails significant morbidity. Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication.
背景/目的：小脑出血是脊柱手术中一种非常罕见且不可预测的并发症。据我们所知，迄今为止尚未有文献记载因插入腰大池-腹腔分流管缓慢引流脑脊液（CSF）而导致小脑出血的情况。
病例报告。
一名47岁女性出现下肢无力。诊断为脊髓动静脉畸形，并接受了手术。其神经功能状态有所改善；然而，术后21天皮下形成一个囊肿样的脑脊液聚集并发生渗漏。患者接受了紧急手术，术中修复了硬脑膜缺损，并置入腰大池-腹腔导管以治疗脑脊液渗漏。12天后发现双侧小脑出血时，移除了腰大池-腹腔引流系统。停止物理治疗，并开始采取包括卧床休息、使用止痛剂、镇静剂以及密切监测血压在内的保守治疗。患者的头痛逐渐缓解；重新开始物理治疗以康复这位患有双下肢轻瘫的患者。
远隔部位小脑出血似乎危及生命且会导致严重的发病率。小脑症状，甚至脊柱手术后出现的迟发性突发头痛，可能是远隔部位小脑出血的迹象，这是一种罕见的并发症。
