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Case Reports
. 2015 Sep 11;3(1):13-16.
doi: 10.2176/nmccrj.cr.2015-0131. eCollection 2016 Jan.

Remote Supratentorial Hemorrhage following Supratentorial Craniotomy: A Case Report

Hirokazu Nagasaki  1 , Kota Yamakawa  1 , Yubuhito Mochizuki  1 , Yoshinori Nakamura  1 , Hitoshi Tokunaga  1 , Yoichi Yoshida  1 , Hiroshi Doi  1
Affiliations
Case Reports

Remote Supratentorial Hemorrhage following Supratentorial Craniotomy: A Case Report

Hirokazu Nagasaki et al. NMC Case Rep J. .

Abstract

Intracranial hemorrhage (ICH) in regions remote from the initial intracranial operation site is rare. The mechanism of ICH following cranial surgery remains unclear, although several theories have been proposed. Most of the reports describe cerebellar hemorrhages after supratentorial procedures or supratentorial hemorrhages after infratentorial procedures. Remote supratentorial hemorrhage (RSH) following supratentorial surgery is extremely rare. We report a case of postoperative RSH occurring away from the surgical site. A 62-year-old woman underwent a right occipital lobectomy to resect lung carcinoma metastases. The patient developed a postoperative consciousness disturbance, and a brain computed tomography (CT) scan revealed an ICH in the left frontal region. The patient underwent ICH evacuation, but remained severely disabled. It is necessary to be aware that this complication is possible after craniotomy.

Keywords: craniotomy; postoperative hemorrhage; remote site hemorrhage.

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Conflict of interest statement

Conflicts of Interest Disclosure The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
T1-weighted magnetic resonance imaging showing a strong enhanced mass in the right occipital lobe.
Fig. 2
Fig. 2
A: T1-weighted magnetic resonance imaging (MRI) showing disseminated lesions. B: Fluid-attenuated inversion recovery (FLAIR) MRI revealing extensive peritumoral edema in the right temporal and occipital lobes.
Fig. 3
Fig. 3
Postoperative computed tomography showing an acute hemorrhage in the left frontal intraparenchyma.
Fig. 4
Fig. 4
A: Preoperative T2-weighted magnetic resonance imaging (MRI) showing massive brain edema with a midline shift. B: T2-weighted MRI performed a month after surgery revealing a decrease in the degree of brain edema and an improvement in the midline shift. It also showed removal of the hematoma in the left frontal lobe.
Fig. 5
Fig. 5
A: Preoperative magnetic resonance venography (MRV) three-dimensional reconstruction (left lateral view) revealing normal venous drainage. B: Follow-up MRV (left lateral view) taken a month after surgery poorly showing the left frontal veins draining into the superior sagittal sinus.
See this image and copyright information in PMC

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