Extensive subdural hematoma and brain herniation following spine surgery: a case report

Abstract

Abstract Background This case is reported due to the rarity of immediate postoperative brain herniation following spinal surgery, a potentially catastrophic complication. It highlights the need for heightened awareness of intracranial hemorrhage (ICH) as a rare but severe complication after spinal surgery, which is usually considered routine. To the best of our knowledge, this represents the first reported case of brain herniation occurring immediately postoperatively. We aim to underscore the significance of this potentially catastrophic complication associated with a procedure that is otherwise considered routine. Case presentation A 60-year-old man with a history of hypertension and cervical spondylosis underwent decompression surgery for lumbar spinal stenosis. Intraoperatively, an accidental dural tear occurred during laminectomy, leading to cerebrospinal fluid (CSF) leakage of approximately 100 mL. The surgery lasted about 5.5 h, with stable vital signs. Fifteen minutes postoperatively, the patient could not be awakened. After around 2 h, both pupils were slightly larger than normal. A cranial CT scan one hour and 30 min later revealed an extensive left hemispheric subdural hematoma (SDH) and brain herniation; the estimated blood loss was approximately 75 mL. Due to financial constraints, the patient’s family refused surgical intervention. Despite supportive treatment in the ICU, the patient’s condition worsened, and he passed away 7 days after discharge against medical advice. Conclusion This case underscores the potential risk of SDH and brain herniation due to significant CSF leakage in patients undergoing spinal surgery. It emphasizes the importance of thorough preoperative evaluation, careful intraoperative management of dural tears and CSF leakage, and immediate postoperative neurological assessment. Anesthesiologists, surgeons, and nursing staff should be vigilant about such rare complications to provide safer and more effective care. The case also highlights the challenge of treatment refusal due to financial constraints, suggesting the need for incorporating the management of rare complications into national policy frameworks.

Keywords

• Subdural hematoma
• Brain herniation
• Lumbar spinal stenosis
• Case report