テント上脳動脈瘤クリッピング術に併発したRemote cerebellar hemorrhageの検討

山口 慎也; 魏 秀復; 宇野 淳二; 伊飼 美明; 古賀 広道; 伊野波 諭; 甲斐 康稔; 藤本 基秋; 前田 一史; 長岡 慎太郎; 西尾 俊嗣

doi:10.2335/scs.37.30

Original Articles

Remote Cerebellar Hemorrhage after Supratentorial Aneurysmal Clipping. A Retrospective Study

Shinya YAMAGUCHI ^†, Hidefuku GI ^†, Jyunji UNO ^†, Yoshiyuki IKAI ^†, Hiromichi KOGA ^†, Satoshi INOHA ^†, Yasutoshi KAI ^†, Motoaki FUJIMOTO ^†, Kazushi MAEDA ^†, Shintarou NAGAOKA ^†, Shunji NISHIO ^†

Author information

Shinya YAMAGUCHI ^†
Department of Neurosurgery, Baba Memorial Hospital
Department of Neurosurgery, Hamanomachi Hospital
Hidefuku GI ^†
Department of Neurosurgery, Baba Memorial Hospital
Jyunji UNO ^†
Department of Neurosurgery, Baba Memorial Hospital
Yoshiyuki IKAI ^†
Department of Neurosurgery, Baba Memorial Hospital
Hiromichi KOGA ^†
Department of Neurosurgery, Baba Memorial Hospital
Satoshi INOHA ^†
Department of Neurosurgery, Baba Memorial Hospital
Yasutoshi KAI ^†
Department of Neurosurgery, Baba Memorial Hospital
Motoaki FUJIMOTO ^†
Department of Neurosurgery, Baba Memorial Hospital
Kazushi MAEDA ^†
Department of Neurosurgery, Baba Memorial Hospital
Shintarou NAGAOKA ^†
Department of Neurosurgery, Baba Memorial Hospital
Shunji NISHIO ^†
Research Core, Baba Memorial Hospital
Author contributions

†These authors contributed equally: Shinya YAMAGUCHI, Hidefuku GI, Jyunji UNO, Yoshiyuki IKAI, Hiromichi KOGA, Satoshi INOHA, Yasutoshi KAI, Motoaki FUJIMOTO, Kazushi MAEDA, Shintarou NAGAOKA, Shunji NISHIO

Keywords: remote cerebellar hemorrhage, supratentorial aneurysmal clipping, unruptured aneurysm, CSF drainage

JOURNAL FREE ACCESS

2009 Volume 37 Issue 1 Pages 30-34

DOI https://doi.org/10.2335/scs.37.30

Details

Abstract

We report 5 cases of remote cerebellar hemorrhage (RCH), which occurs rarely after supratentorial aneurysmal clipping. Among 501 consecutive cases, who were operated on for their supratentorial cerebral aneurysms (unruptured 174 cases; ruptured 327 cases) in our facility between 2002 and 2007, 5 (unruptured 4; ruptured 1) were found to have RCH. RCH was not found on the first CT scan taken within an hour after surgery but was detected between 4 hours and 8 days after surgery. Postoperative epidural drainage in RCH cases amounted to more than 200 ml per 4 hours. While several risk factors for this hemorrhage have been reported, hemorrhage along the cerebellar folia and delayed occurrence suggested that the disturbed cerebellar venous drainage caused by excessive CSF drainage during the perioperative period was the cause of this hemorrhage.
While the pathogenesis of RCH has not fully been elucidated, excessive CSF drainage should be avoided during supratentorial aneurysm surgery.

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