Supratentorial subdural hematoma following microvascular decompression

Background: Hemorrhage is the most common during microvascular decompression (MVD) for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GN). However, remote supratentorial subdural hematoma is very rare, especially for those patients who reveal severe intraoperative venous bleeding without a definite bleeding source in the suboccipital surgical area, and immediate postoperative computed tomography (CT) reveals supratentorial subdural hematoma. The underlying mechanisms remain obscure. We report 10 cases to discuss the pathophysiology and develop appropriate therapeutic strategies for prevention and treatment. Patients and methods: We retrospectively analyzed clinical data of patients who underwent microvascular decompression in Nanjing Drum Tower Hospital between December 1, 2018 and December 31, 2020. Among 764 patients, bleeding events occurred in 10 cases, whose bleeding origin was not confirmed intraoperatively and immediate postoperative CT revealed supratentorial subdural hematoma. We reviewed characteristics, the intraoperative situations and the prognosis of the 10 cases. Results: The mean age of the patients was 55.4 years; 2 was male and 8 were female. All patients revealed draining large amounts of intraoperative cerebrospinal fluid (CSF) during the operation. Primary unknown cause of severe venous bleeding of 8 patients occurred in different time periods intraoperatively. However, hemorrhage all occurred in a very early stage before decompression. The operation was completed successfully in the 8 patients through the irrigation and drainage of the bloody cerebrospinal fluid. patient Postoperative CT indicated supratentorial acute subdural hematoma (ASDH) with hematoma volume