A Report of 2 Cases of Brainstem Hemorrhage After Suboccipital Craniectomy for Chiari Decompression. Issue 5 (11th July 2017)

• Record Type: Journal Article
• Authors: Polster, Sean P; Dougherty, Mark C; Zeineddine, Hussein A; Lee, Seon-Kyu; Frim, David
• Is Part Of: Operative neurosurgery. Volume 14:Issue 5(2018)
• Page Start: E58
• Page End: E62
• Publication Date: 2017-07-11
• Subjects: Brainstem hemorrhage -- Chiari -- Decompression -- Case report; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opx146
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND AND IMPORTANCE: Decompression surgery for Chiari malformation is known to have very low procedure-related complications. There has been no report of post-Chiari malformation decompression surgery development of brainstem hemorrhage. We report 2 post-Chiari decompression surgery brainstem hemorrhage cases with 2-yr follow-up. CLINICAL PRESENTATION: Two cases were reviewed in which patients underwent uncomplicated suboccipital craniectomy with expansive autologous pericranium duraplasty for Chiari decompression. Postoperatively, both patients awoke with hemibody sensory and motor deficits. Immediate postoperative magnetic resonance imaging revealed a small hemorrhage within the dorsal medulla in both cases. Follow-up imaging shows resolution along with near complete clinical recovery of deficits. CONCLUSION: These cases demonstrate a rare postdecompression surgery-related complication in Chiari malformation. We hypothesize that these hemorrhages may occur from the rapid drainage of cerebrospinal fluid resulting in a loss of positive pressure, allowing a low-pressure hemorrhage to occur. Given that these hemorrhages are of low pressure, recovery is excellent.