Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2？mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings. 1. Introduction It is reported that the rate of dural tear during spinal surgery is 1%–17%, and while it can be associated with surgical technique, it can also be related to patient factors like “thin dura” or “dural adhesions” [1]. Intracranial hypotension resulting from an excessive CSF leak due to a dural tear causes postural headaches, photophobia, and altered mental status. Usually this condition improves with bed rest and fluid supply for a few days. Another rare complication caused by CSF leak during a spinal surgery is intracranial hemorrhage. In the presence of neurological deterioration in cases of intraoperative dural tear and CSF leak, a careful evaluation must be done in terms of cerebellar hemorrhage. While most of these bleedings occur in cerebellar localization, it can occur rarely in subdural or epidural spaces [1–3]. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings. 2. Case A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2？mm dural tear. A hemorrhage with parallel streak on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period (Figures 1, 2, and 3). Both cranial MRI angiography and venography were normal. Patient’s coagulation tests were normal as well as his blood pressure. Patient was given fluid replacement, antiedema therapy (4？mg dexamethasone every