Remote cerebral and cerebellar hemorrhage after removal of supratentorial Ganglioglioma: A case report and review of the literature

Abstract

Background: Postoperative surgical site hematomas are one of the most frequently reported complications in neurosurgery. However, multiple hemorrhages occurring distant from the site of operation are uncommon. Different studies proposed several mechanisms, including coagulation disorders, chronic increased intracranial pressure, sudden decompression, and excessive CSF loss. Despite that, the exact pathophysiology remains obscure. Here we report a case of multiple remote hemorrhages in a 26-year-old patient who underwent resection of a frontal ganglioglioma. We review the current literature on pathomechanisms. Case description: A 26-year-old female presented with an 11-year history of progressive global headache and bilateral visual loss. Preoperative imaging showed a huge complex anterior cranial fossa mass extending into the ethmoid sinus. The patient developed a generalized tonic-clonic seizure in the immediate postoperative hours. On CT scan, we found multiple cerebral and cerebellar hemorrhages. Seizure-controlled, hemorrhages managed conservatively and discharged the patient without a new neurologic deficit. Conclusion: Remote site intraparenchymal hemorrhages are rare. Despite several theories, the exact pathophysiologic mechanism is still yet unexplained. Clinicians must keep a high index of suspicion to diagnose this rare complication at an early stage. Above all, one should avoid sudden decompression of a long-standing, huge supratentorial mass lesion.

Keywords

• Craniotomy
• Ganglioglioma
• Remote intracerebral hemorrhage
• Remote cerebellar hemorrhage
• Surgical site hemorrhage