Division of Neurosurgery, Department of Surgery, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, Taiwan, ROC; National Yang-Miing University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2013 Oct;76(10):593-8. doi: 10.1016/j.jcma.2013.02.006. Epub 2013 Jun 5.
Remote cerebellar hemorrhage (RCH) is an unpredictable and rare complication of spinal surgery. We report five cases of RCH following cervical spinal surgery, and summarize another seven similar cases from the literature. Dural opening with cerebrospinal fluid (CSF) hypovolemia seems to be an important factor contributing to RCH following cervical spinal surgery. As other authors have proposed, surgical positioning may be another factor contributing to RCH. RCH is thought to be hemorrhagic venous infarction, resulting from the stretching occlusion of the superior cerebellar vein by the cerebellar sag effect. Either intraoperative CSF loss or a postoperative CSF leak from drainage may cause cerebellar sag, further resulting in RCH. RCH is usually self-limiting, and most patients with RCH have an optimal outcome after conservative treatment. Severe cases that involved surgical intervention because of evidence of brainstem compression or hydrocephalus also had acceptable outcomes, compared to spontaneous CH. It has been suggested that one way to prevent RCH is to avoid extensive perioperative loss of CSF, by paying attention to surgical positioning during spinal surgery. We also underline the importance of early diagnosis and CSF expansion in the early treatment of RCH.
远程小脑出血（RCH）是脊髓手术后不可预测且罕见的并发症。我们报告了 5 例颈椎手术后 RCH，并总结了文献中的另外 7 例类似病例。硬脑膜切开伴脑脊液（CSF）低容量似乎是颈椎手术后 RCH 的一个重要因素。正如其他作者所提出的，手术体位可能是导致 RCH 的另一个因素。RCH 被认为是出血性静脉梗死，是由于小脑下垂效应导致上小脑静脉伸展闭塞所致。术中 CSF 丢失或术后引流引起的 CSF 漏出都可能导致小脑下垂，进而导致 RCH。RCH 通常是自限性的，大多数 RCH 患者经保守治疗后预后良好。因证据表明存在脑干压迫或脑积水而需要手术干预的严重病例，与自发性 CH 相比，也有可接受的结果。有人建议，一种预防 RCH 的方法是避免围手术期大量 CSF 丢失，在脊髓手术过程中注意手术体位。我们还强调了早期诊断和早期 CSF 扩张在 RCH 治疗中的重要性。
