Remote Cerebellar Hemorrhage after Intradural Disc Surgery
A 66-year-old male patient complained severe back pain and radiating pain to both leg for several days. Spinal MRI demonstrated a huge intradural mass compressing conus medullaris and cauda equina at the L1-2 level, with slight ring enhancement on the surroundings (). He was very healthy previously and did not have any risk factor for stroke.\nA laminotomy on the appropriate level was done and dura was opened vertically. On the ventral side, there was a large dural opening and through the defect a large intradural disc material was extruded. The ruptured disc was removed totally with microsurgical piecmeal technique. In order to minimize post operative CSF leakage ventral defect and dorsal dural opening was closed watertightly. Fibrin sealant was covered on the sutured area and lamina was replaced with miniplate fixation. On postoperative MRI, it was removed successfully ().\nOn the day after surgery, blood mixed with CSF came through the drainage bag, and the patient was instructed to take a rest in lying position. After operation his back pain was minimized and radicular pain was disappeared and the patient frequently took a sitting position against medical advice and about 300 cc of CSF was drained just within 4 hours.\nTwo days after the surgery, the patient complained unexpected headache, dizziness, nausea and vomiting, while neurological condition was stable, pupillary reflex on both eyes were normal as well as limb motor power, but horizontal nystagmus was detected on both eyes. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage with size of 3×3 cm on the right cerebellum and 1.5×1 cm on the left cerebellum. While brain stem was not compressed, fourth ventricle was distorted and headache was aggravated, leaving the decision to surgery (). Suboccipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed (). After craniotomy, the patient showed clinical improvement. He was able to leave the hospital after two weeks of initial operation without any neurological deficit.