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

초록

objectives: To elucidate the possible mechanisms of remote intracerebral hemorrhages following intracranial aneurysm surgery Material and methods: A total of 198 postoperative remote ICH have been observed in 18 patients, we reviewed their radiological characteristics and evluated various perioperative parameters. Results: Incidence was 2.3%(19of823 open surgeries). All of them developed after pterional approach and most of them(18of 20) were detected on the immediate postoperative CT scan. Eleven cases have been occurred in supratentorial area, 7 incerebellum, and one in both area. Thery could have been grouped into three types, frontal lobar(7) type, cerebellar type(8) and other areas(5). Frontal hemorrhages have occurred on the same side of operation. the 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 angiographjy and three of them have occurred in the low density area on the preoperative CT scan. the remote cerewbellar hemorrhages developed unilaterally(2ipsilateral, 2 contralateral) in four cases and bilaterally in four. All of them developed in the superior part of cerebellum, which area drain maily into the vein of Galen via auperior cerebellar venous system conclusion: Postoperative remote ICH following intracranial aneurysm surgery semms to be manifestation of hemorrhagic infarction. Frontal hemorrhages and cerebellar hemorrhages semms to be not a unique phenomenon related with aneurysm surgeries and to be related with compromized venous drainage. Postoperative supratentorial hemorrhagess followingn aneurysm surgery seem to be concerned with special circumstanced of ruptured aneurysm and it may be related hemodynamic instability duriong operation on the silent infa