A Case of Cerebellar Hemorrhage with Cerebral Hemisphere Swelling after Supratentorial Craniotomy

Abstract

A 61-year-old woman underwent right frontotemporal craniotomy for a right unruptured ophthalmic aneurysm. The aneurysm was obliterated with a clip with no troubles either during surgery or the anesthetic course. Postoperatively, the patient awoke fully from anesthesia and no neurological abnormality was noticed. However, the following day, her movement was ataxic and CT scan demonstrated diffuse swelling of the right hemisphere and subpial hemorrhagic infarction caused by venous congestion on diffuse cerebellum. Angiograms obtained on the ninth postoperative day showed disappearance of the aneurysm and no other vascular abnormalities including venous circulation of the posterior fossa were observed. Although the patient was discharged home without neurological deficit, swelling of the right cerebral hemisphere on CT scans had been existed for next two years. Although the mechanisms of venous congestion on the cerebellum remain unclear, we belive that postoperative cerebrospinal fluid overdrange may play an important role and disturbed venous circulation of the righthemisphere may acceletrate this process.