Nonaneurysmal subarachnoid hemorrhage : rare complication of vertebroplasty

Abstract

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

Keywords: Complication; Nonaneurysmal subarachnoid hemorrhage; Valsalva maneuver; Vertebroplasty.

Fig. 1

A 74-year-old woman with multiple compression fractures on the dorsal and lumbar spines treated by vertebroplasty. Cement radioopacities are noted in the thoracolumbar spine bodies (A). Subarachnoid hemorrhage and intraventricular hemorrhage is demonstrated on cerebral computed tomography scan after spine procedure (B). Three-dimensional computed tomography angiography does not depict any vascular abnormalities (C).

Fig. 2

A 65-year-old woman who complicated with nonaneurysmal subarachnoid hemorrhage following percutaneous vertebroplasty. Cement was leaked into the paravertebral muscles (A). Computed tomography after spine intervention shows subarachnoid hemorrhage and ventricular hemorrhage (B). Vascular lesions on the both carotid and vertebrobasilar trees except basilar artery fenestration are not detected on magnetic resonance angiography (C) and catheter angiography (D, E and F).