Remote ICHs following intracranial aneurysm surgery - Is it a manifestation of hemorrhagic infarction?/ Lesson from radiologic observations

초록

Obs ; To elucidate the possible mechanisms of remote intracerebral hemorrhages following intracranial aneurysm in aneurismal surgery Material and Methods ; A total of 19 postoperative remote ICH have been observed in 18 patients. We reviewed their radiological characteristics and evaluated various perioperative parameters Results ; Incidence was 2.3%. All of them developed after pterional approach and most of them were detected on the immediate postoperative CT scan. Eleven cases have been occurred in supretentorial area, 7 in cerebellum, and one in both areas. They could have been grouped into three types, frontal lobar(7) type, cerebellar type(8) and other sras(5). Frontal hemorrhages have occurred on the same side of operation. Th compromised sylvian venous system has been observed in the 3 of 7 frontal lobe hemorrhages. Other supratentorial hemorrhages have never occurred after surgeries for unruptured aneurysm and early surgeries for ruptured aneurysm. In one of other supratentorial hemorrhages, we have observed the evidence of severe vasospasm on the preoperative angiography and three of them have occurred in the low density area on the preoperative CT scan. The remote cerebellar hemorrhages developed unilaterally(2 ipsilateral, 2 contralateral) in four cases and bilaterally in four. All of tem developed in the superior part of cerebellum, which areas drain mainly into the vin of Galen via superior cerebellar venous system. Conclusion ; Postoperative remote ICH following intracranial aneurysm surgery seems to be manifestation of hemorrhagic infarction. Frontal hemorrhage and cerebellar hemorrhages seems to be not a unique phenomenon related with aneurysm surgeries and to be related with compromised venous drainage. Postoperative supratentorial hemorrhages following aneurysm surgery seem to be concerned with special circumstances ofruptured aneurysm and it may be related with hemodynamic instability during operation on the silent infarction