Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 993.e13-993.e17
World Neurosurgery

Case Report
Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood

https://doi.org/10.1016/j.wneu.2017.08.189Get rights and content

Background

Spinal subdural hematomas (SSDHs) are rare and usually associated with bleeding diatheses, trauma, iatrogenic injury, spinal vascular malformations, or intraspinal tumors.

Case Description

We report a case of a 75-year-old man who developed a symptomatic lumbosacral SSDH after undergoing resection of a right temporal glioblastoma multiforme. The patient subsequently recovered and was discharged home. Over the next 2 weeks, he developed progressively worsening symptoms of lower back pain, lower extremity weakness, and urinary retention. Although the patient had no known risk factors for developing a SSDH, magnetic resonance imaging on postoperative day 16 revealed an extensive L2-sacrum SSDH. The patient underwent L2–L5 total laminectomies for evacuation of the SSDH. His symptoms resolved after surgery. Literature review produced 26 other cases of SSDHs after intracranial surgery in patients without obvious risk factors. In our case, the lumbosacral SSDH may have originated from downward migration of intracranial blood in a gravity-dependent fashion. Radiographic evidence of blood within the posterior thecal sac of the patient's cervical spine supports this hypothesis.

Conclusions

In most cases, SSDHs after intracranial surgery resolve with conservative treatment; however, as shown in our case, surgery may be required if there is progressive neurologic decline. Neurosurgeons should be aware of this potential complication after intracranial surgery; a magnetic resonance imaging of the spine may be indicated if there is unexplained lower extremity pain or weakness.

Introduction

Spinal subdural hematomas (SSDHs) are rare and usually associated with bleeding diatheses due to hematologic disease or anticoagulation therapy, trauma, iatrogenic injury such as lumbar puncture or previous spine surgery, spinal vascular malformations, or intraspinal tumors.1, 2 In the absence of these risk factors, the occurrence of SSDHs after intracranial surgery is exceedingly rare.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 We report a case of SSDH that developed after intracranial tumor resection.

Section snippets

Case Report

The patient was a 75-year-old man with history of hypertension, prostate cancer, depression, and seizures. Magnetic resonance imaging (MRI) of the brain was obtained after the patient had 2 syncopal episodes. This revealed a necrotic, peripherally enhancing mass in the right anterior temporal lobe suggestive of a primary high-grade glioma. The patient underwent a right temporal craniotomy, and gross total resection of the tumor was achieved.

Although the patient had a nonlocalizing neurologic

Discussion and Literature Review

SSDH is a rare occurrence and usually is associated with coagulopathy (blood dyscrasias or therapeutic anticoagulation), trauma, iatrogenic injury (lumbar puncture or previous spine surgery), spinal vascular malformations, or intraspinal tumors.1, 2 Nontraumatic SSDHs occurring as a complication after intracranial surgery have been reported only in sporadic case reports in the literature.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 There was no obvious etiology for the

Conclusions

We reported a case of a symptomatic lumbosacral SSDH that followed temporal glioblastoma multiforme resection in a patient with no known risk factors such as bleeding diathesis, trauma, lumbar puncture, spine surgery, spinal vascular malformation, or intraspinal tumor. We may have radiographic evidence of intracranial blood as it migrates downward into the cervical spine (Figure 1C) before settling in the most gravity-dependent portion of the lumbosacral spine. The degree to which subarachnoid

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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