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      Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

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          Abstract

          BACKGROUND

          Intracranial hemorrhage after spinal surgery is a rare and devastating complication.

          AIM

          To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery.

          METHODS

          A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded.

          RESULTS

          A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019).

          CONCLUSION

          The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

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          Most cited references21

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          Emerging concepts in sporadic cerebral amyloid angiopathy.

          Andreas Charidimou, Grégoire Boulouis, M Edip Gurol … (2017)
          Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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            Remote cerebellar hemorrhage: a review.

            Christoph Groden, Marc Brockmann (2005)
            Remote cerebellar hemorrhage remains a complication rarely occurring after supratentorial surgery (<5%) and presumably even less frequent after spinal surgery. Although the pathomechanisms leading to RCH with its typical bleeding pattern are still not definitely understood, intra- or even more likely postoperative loss of larger volumes of CSF seem to be related to this complication. Prognosis significantly depends on severity of hemorrhage and patient age. Outcome in more than 50% of all cases is good with only mild remaining neurological symptoms or complete recovery, while death occurs in approximately 10-15%. Close monitoring of patients undergoing surgery that involves the risk of draining large volumes of CSF is mandatory and patients with postoperative drainage of larger amounts of fluid acquire increased attentiveness. Early detection and correct interpretation of the typical bleeding pattern might help to avoid further aggravation of symptoms. This review will address incidence, typical appearance and pathophysiological considerations, as well as risk factors, treatment options, and outcome related with RCH.
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              Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association.

              Curtis Benesch, Laurent Glance, Colin Derdeyn … (2021)
              Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.
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                Author and article information

                Contributors
                Xin Yan
                Li-Rong Yan
                Zhi-Gang Ma
                Ming Jiang
                Yang Gao
                Ying Pang
                Wei-Wei Wang
                Zhao-Hui Qin
                Yang-Tong Han
                Xiao-Fan You
                Wei Ruan
                Qian Wang
                Journal
                Journal ID (nlm-ta): World J Clin Cases
                Journal ID (publisher-id): WJCC
                Title: World Journal of Clinical Cases
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2307-8960
                Publication date (Print): 16 August 2023
                Publication date (Electronic): 16 August 2023
                Volume: 11
                Issue: 23
                Pages: 5430-5439
                Affiliations
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China. ynxn0403@ 123456163.com
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
                Author notes

                Author contributions: Yan X contributed to conceptualization, methodology, investigation, writing - original draft, supervision; Yan LR, Ma ZG, Jiang M, Pang Y, Wang WW, Qin ZH, Han YT, You XF, Ruan W, Wang Q contributed to investigation, data curation, writing - review & editing; Gao Y contributed to data retrieval.

                Supported by “Xue Ke Xin Xing” of Beijing Jishuitan Hospital, Beijing, China, No. XKXX201611.

                Corresponding author: Xin Yan, MD, Associate Chief Physician, Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, No. 68 Huinan Beilu, Changping District, Beijing 100096, China. ynxn0403@ 123456163.com

                Article
                Other ID: jWJCC.v11.i23.pg5430
                DOI: 10.12998/wjcc.v11.i23.5430
                PMC ID: 10450377
                SO-VID: 8c1a6618-b1ea-466e-bc92-68f7c32cf57b
                Copyright © ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 24 May 2023
                Date revision received : 4 July 2023
                Date accepted : 18 July 2023
                Categories
                Subject: Retrospective Cohort Study

                Keywords: spinal surgery,intracranial hemorrhage,risk factors,economic burden,dura mater damage
                Data availability:
                Keywords: spinal surgery, intracranial hemorrhage, risk factors, economic burden, dura mater damage

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