Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: case report

anp Arquivos de Neuro-Psiquiatria Arq. Neuro-Psiquiatr. 0004-282X 1678-4227 Academia Brasileira de Neurologia - ABNEURO São Paulo, SP, Brazil The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension. Hemorragia de tronco cerebral após remoção cirúrgica de cisto aracnóide da fissura silviana. Relato de caso Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: case report Guilherme BorgesI; Yvens B. FernandesII; Nevair R. GallaniIII IProfessor Assistente Doutor;Disciplina de Neurocirurgia da Faculdade de Ciências Médicas da UNICAMP IIMédico Residente IIIPós-Graduando RESUMO Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecção de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensão intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores são discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuição do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia parenquimatosa em casos como o relatado permanece obscura. Uma abordagem cirúrgica mais cautelosa é proposta nesses pacientes com de hipertensão intracraniana. Palavras-chave:cisto aracnóide, craniotomia, hemorragia do tronco cerebral, complicação cirúrgica. SUMMARY The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension. Key-words: arachnoid cyst, craniotomy, brainstem hemorrhage, surgical complication Texto completo disponível apenas em PDF. Full text available only in PDF format. Agradecimentos - Os autores agradecem ao Dr. Hugo L. F. Brito pelo material anátomo-patológico. Dr Guilherme Borges - Rua Barão Geraldo de Rezende 282 - 13020-440 Campinas SP - Brasil. 1.  Aicardi J, Bauman F. 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