Temporobasal Hemorrhage Following Retrosigmoid Resection of Cerebellopontine Angle Meningioma: A Rare Surgical Complication

The authors aim to report a rare case of supratentorial temporobasal hemorrhage occurring after resection of a cerebellopontine angle (CPA) meningioma through a retrosigmoid approach and to elucidate the underlying mechanisms of this postoperative complication while offering surgical insights to prevent its occurrence. In the present study, the authors report a case of a 52-year-old female patient admitted for "dizziness for 1 year, exacerbated over the past 3 months". Preoperative magnetic resonance imaging (MRI) revealed a 2.5 cm×2 cm ×2 CPA meningioma, classified as Simpson grade I, attached to the right petrous bone and tentorium cerebelli. The patient underwent gross total resection (GTR) through a retrosigmoid approach. Intraoperatively, tumor invasion into the tentorium was found, with slow oozing from the tentorial layer during resection, controlled by repeated electrocoagulation. Three hours postoperatively, the patient's consciousness deteriorated. Emergency computed tomography (CT) revealed a massive supratentorial temporobasal hemorrhage, prompting urgent hematoma evacuation. The patient fully recovered without neurological sequelae after hematoma evacuation. The authors propose that excessive electrocoagulation during resection may have impaired temporobasal venous drainage, leading to hemorrhage. This case illustrates a novel mechanism underlying surgical hemorrhagic complications and underscores the importance of hemostasis techniques during resection of the tumor within the tentorial layer, as well as the protection of temporobasal venous drainage.