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. 2016 Apr 7:2:15040.
doi: 10.1038/scsandc.2015.40. eCollection 2016.

Intracranial epidural hemorrhage during lumbar spinal surgery

Yasuaki Imajo  1 , Tsukasa Kanchiku  1 , Hidenori Suzuki  1 , Yuichiro Yoshida  1 , Norihiro Nishida  1 , Hisaharu Goto  2 , Michiyasu Suzuki  2 , Toshihiko Taguchi  1
Affiliations

Intracranial epidural hemorrhage during lumbar spinal surgery

Yasuaki Imajo et al. Spinal Cord Ser Cases. .

Erratum in

Abstract

The authors report a case of intracranial epidural hemorrhage (ICEH) during spinal surgery. We could not find ICEH, though we recorded transcranial electrical stimulation motor evoked potentials (TcMEPs). A 35-year-old man was referred for left anterior thigh pain and low back pain that hindered sleep. Sagittal T2-weighted magnetic resonance imaging revealed an intradural tumor at L3-L4 vertebral level. We performed osteoplastic laminectomy and en bloc tumor resection. TcMEPs were intraoperatively recorded at the bilateral abductor digiti minimi (ADM), quadriceps, tibialis anterior and abductor hallucis. When we closed a surgical incision, we were able to record normal TcMEPs in all muscles. The patient did not fully wake up from the anesthesia. He had right-sided unilateral positive ankle clonus 15 min after surgery in spite of bilateral negative of ankle clonus preoperatively. Emergent brain computed tomography scans revealed left epidural hemorrhage. The hematoma was evacuated immediately via a partial craniotomy. There was no restriction of the patient's daily activities 22 months postoperatively. We should pay attention to clinical signs such as headache and neurological findgings such as DTR and ankle clonus for patients with durotomy and cerebrospinal fluid (CSF) leakage. Spine surgeons should know that it was difficult to detect ICEH by monitoring with TcMEPs.

Keywords: Evoked potentials; Risk factors.

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Figures

Figure 1
Figure 1
Transcranial electrical stimulation motor evoked potentials (TcMEPs) were recorded from bilateral abductor digiti minimi (ADM), quadriceps, tibialis anterior (TA), and abductor hallucis (AH). Control wave forms were recorded at 11:34:27 (arrow head). Final wave forms at the end of the operation were recorded at 13:24:44 (arrow). The amplitude of the final TcMEPs was increased compared with that of the TcMEPs at the control wave form in all recorded muscles.
Figure 2
Figure 2
Emergent brain computed tomography showing the epidural hemorrhage. No bony fracture was present.
See this image and copyright information in PMC

References

    1. Huang PH , Wu JC , Cheng H , Shih YH , Huang WC . Remote cerebellar hemorrhage after cervical spinal surgery. J Chin Med Assoc 2013; 76: 593–598. - PubMed
    1. Li ZJ , Sun P , Dou YH , Lan XL , Xu J , Zhang CY et al. Bilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery. –Case report-. Neurol Med Chir (Tokyo) 2012; 52: 646–648. - PubMed
    1. Grahovac G , Vilendecic M , Chudy D , Srdoc D , Skrlin J . Nightmare complication after lumbar disc surgery. Spine 2011; 36: E1761–E1764. - PubMed
    1. Kaloostian PE , Kim JE , Bydon A , Sciubra DM , Wolinsky JP , Gokaslan ZL et al. Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013; 19: 370–380. - PubMed
    1. Ma X , Zhang Y , Wang T , Li G , Zhang G , Khan H et al. Acute intracranial hematoma formation following excision of a cervical subdural tumor: a report of two cases and literature review. Br J Neurosurgery 2014; 28: 125–130. - PubMed