Epidural hematoma: postoperative complication
DOI:
https://doi.org/10.18203/2349-2902.isj20172412Keywords:
Epidural hematoma, Traumatic brain injury, Ventriculoperitoneal shuntAbstract
Epidural hematoma is an indication for emergency neurosurgical intervention. This condition is an extremely rare postoperative complication of ventriculoperitoneal shunt and contralateral decompressive craniectomy. A 22-year-old male patient was admitted to our clinic with headache and a decline in the level of consciousness. We detected a left thalamic astrocytoma and hydrocephalus, which we treated via ventriculoperitoneal shunt surgery and ventricular drainage in emergency conditions. The patient experienced dysphasia on the first postoperative day and we found a right frontoparietal epidural hematoma. We evacuated the hematoma and exchanged the medium pressure valve for a high-pressure valve. The second patient was a 19-year-old male who had been assaulted. His pupils were fixed and dilated and had no reaction to painful stimulus. We detected bilateral frontotemporal skull fractures and right frontotemporoparietal subdural and epidural hematomas. We performed a right decompressive craniectomy and subdural/epidural hematoma evacuation followed by recovery under sedation in the intensive care unit. We performed cranial computed tomography six hours after surgery and found a left temporoparietal epidural hematoma. We performed a left temporoparietal craniotomy and epidural hematoma evacuation. The patient exhibited a higher level of consciousness and increased movement of his extremities. Epidural hematoma is a life-threatening complication encountered in neurosurgery practice. Neurosurgeons should be aware of the possibility of epidural hematoma following ventriculoperitoneal shunt or traumatic brain injury surgery.
Metrics
References
Paiva WS, Andrade AF, Mathias JL, Guirado VM, Amorim RL, Magrini NN. Management of supratentorial epidural hematoma in children: Report on 49 patients. Arq Neuropsiquiatr. 2010;68:888-92.
Naradzay JF, Browne BJ, Rolnick MA, Doherty RJ. Cerebral ventricular shunts. J Emerg Med. 1999;2:311-22.
Noleto G, Neville IS, Tavares WM, Felippe S, Pinto FC, Teixeira MJ. Giant acute epidural hematoma after ventriculoperitoneal shunt: A case report and literature review. Int J Clin Exp Med. 2014;7(8):2355-9.
Louzada PR, Requejo PR, Barroso MV, Vaitsman RP, Machado AL, Paiva MS. Bilateral extradural haematoma after acute ventricular over-drainage. Brain Injury. 2012;26:95-100.
Meguins LC, Sampaio GB, Abib EC, da Cruz Adry RAR, Ellakkis RFEH, Ribeiro FWJ. Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): A case report. J Med Case Rep. 2014;8:153.
Sengupta RP, Hankinson J. Extradural haemorrhage- A hazard of ventricular drainage. J Neurol Neurosurg Psychiatry. 1972;35:297-303.
Bokhari R, Baeesa S. Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: A case report. J Med Case Rep. 2012;6:222.
Sasani M, Sasani H, Ozer AF. Bilateral late remote cerebellar hemorrhage as a complication of a lumbo-peritoneal shunt applied after spinal arteriovenous malformation surgery. J Spinal Cord Med. 2010;33(1):77-9.
Shin D, Woo HJ, Park J. Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage: risk Factors Associated with Ventriculoperitoneal Shunt. J Korean Neurosurg Soc. 2012;52(4):320-4.
Vinay B, Shruti R, Bhadrinarayan V. Delayed incidental diagnosis of postoperative extradural hematoma following ventriculoperitoneal shunt. J Neurosci Rural Pract. 2015;6(1):94-6.
Desai VR, Grossman R, Sparrow H. Incidence of intracranial hemorrhage after a cranial operation. Cureus. 2016;8(5):E616.
Seyithanoglu H, Guzey FK, Emel E, Ozkan N, Aycan A. Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion: A case report. Turkish Neurosurg. 2010;20:519-23.
Odake G, Matsumoto S. Supratentorial epidural hematoma as a complication of internal decompression-one personal and 42 reported cases. Neurol Med Chir (Tokyo). 1981;21(8):897-905.
Higazi I. Epidural hematoma as complication of ventricular drainage: report of a case and review of literature. J Neurosurg. 1963;20:527-8.
Fujimoto Y, Aguiar PH, Carneiro JD, Martins RS, Ciquini O Jr, de Andrade AF. Spontaneous epidural hematoma following a shunt in an infant with congenital factor X deficiency: Case report and literature review. Neurosurg Rev. 1999;22:226-9.
Driesen W, Elies W. Epidural and subdural haematomas as a complication of internal drainage of cerebrospinal fluid in hydrocephalus. Acta Neurochir (Wien). 1974;30:85-93.
Pereira CU, Porto MW, de Holanda RR, de Andrade WT. Epidural hematoma after ventriculoperitoneal shunt surgery. Report of two cases. Arq Neuropsiquiatr. 1998;56:629-32.
Mishra SS, Satapathy MC, Senapati SB. Shunt site chronic calcified extradural hematoma: an avoidable complication. J Pediatr Neurosci. 2014;9(2):166-8.
Power D, Ali-Khan F, Drage M. Contralateral extradural haematoma after insertion of a programmable-valve ventriculoperitoneal shunt. J R Soc Med. 1999;92(7):360-1.
Harkness W. Contralateral extradural haematoma after ventriculoperitoneal shunt insertion. J R Soc Med. 1999;92(10):547.
Choi JU, Kim DS, Kim SH. Endoscopic surgery for obstructive hydrocephalus. Yonsei Med J. 1999;40:600-7.
Cinalli G, Salazar C, Mallucci C, Yada JZ, Zerah M, Sainte-Rose C. The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery. 1998;43:1323-7.
Hamlat A, Heckly A, Doumbouya N, Seigneuret E, Brassier G. Epidural hematoma as a complication of endoscopic biopsy and shunt placement in a patient harboring a third ventricle tumor. Pediatr Neurosurg. 2004;40:245-8.
Zalatimo O, Iantosca M. Epidural hematoma as a complication of endoscopic third ventriculostomy in a patient with aqueductal stenosis. JSM Neurosurg Spine. 2013;1(1):1002.
Boviatsis EJ, Korfias S, Kouyialis AT, Sakas DE. Epidural haematoma after evacuation of contralateral subdural haematoma. Ir J Med Sci. 2004;173(4):217-8.
Meguins LC, Sampaio GB, Abib EC, da Cruz Adry RAR, Ellakkis RFEH, Ribeiro FWJ, et al. Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): A case report. J Med Case Rep. 2014;8:153.
Mohindra S, Mukherjee KK, Gupta R, Chhabra R, Gupta SK, Khosla VK. Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: A report of two cases and review of literature. Br J Neurosurg. 2005;19(6):490-4.
Saberi H, Meybodi AT, Meybodi KT, Habibi Z, Mirsadeghi SM. Delayed postoperative contralateral epidural hematoma in a patient with right-sided acute subdural hematoma: A case report. Cases J. 2009;2:6282.
Shen J, Pan JW, Fan ZX, Zhou YQ, Chen Z, Zhan RY. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: Five new cases and a short literature review. Acta Neurochir (Wien). 2013;155(2):335-41.
Su TM, Lee TH, Chen WF, Lee TC, Cheng CH. Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: Clinical features and outcome. J Trauma. 2008;65(6):1298-302.
Panourias IG, Skandalakis PN. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication. Clin Neurol Neurosurg. 2006;108(4):396-9.
Matsuno A, Katayama H, Wada H, Morikawa K, Tanaka K, Tanaka H. Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma. Surg Neurol. 2003;60(1):23-30.