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Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood.
World Neurosurg. 2017 Dec; 108:993.e13-993.e17.WN

Abstract

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.

Authors+Show Affiliations

Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: gmp9ke@hscmail.mcc.virginia.edu.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28890010

Citation

Paisan, Gabriella M., et al. "Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood." World Neurosurgery, vol. 108, 2017, pp. 993.e13-993.e17.
Paisan GM, Buell TJ, Raper D, et al. Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood. World Neurosurg. 2017;108:993.e13-993.e17.
Paisan, G. M., Buell, T. J., Raper, D., & Asthagiri, A. (2017). Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood. World Neurosurgery, 108, e13-e17. https://doi.org/10.1016/j.wneu.2017.08.189
Paisan GM, et al. Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood. World Neurosurg. 2017;108:993.e13-993.e17. PubMed PMID: 28890010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood. AU - Paisan,Gabriella M, AU - Buell,Thomas J, AU - Raper,Daniel, AU - Asthagiri,Ashok, Y1 - 2017/09/07/ PY - 2017/07/04/received PY - 2017/08/28/revised PY - 2017/08/30/accepted PY - 2017/9/12/pubmed PY - 2017/12/27/medline PY - 2017/9/12/entrez KW - Concomitant KW - Glioblastoma multiforme KW - Lumbar spine KW - MRI KW - Spinal cord injury KW - Subdural hematoma SP - 993.e13 EP - 993.e17 JF - World neurosurgery JO - World Neurosurg VL - 108 N2 - 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. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28890010/Lumbosacral_Subdural_Hematoma_After_Glioblastoma_Multiforme_Resection:_Possible_Radiographic_Evidence_for_the_Downward_Migration_of_Intracranial_Blood_ DB - PRIME DP - Unbound Medicine ER -