Intraoperative Subdural and Postoperative Brainstem Hemorrhage in Glioma Surgery: A Case Report

BACKGROUND Postoperative hemorrhage is a rare yet significant complication following craniotomy, with reported incidence rates ranging from 0.8% to 10.8%. This complication can lead to severe morbidity, with a notable survival rate decline among patients requiring reoperation for hematoma evacuation. Remote intraoperative hemorrhage is exceptionally rare and often associated with a poor prognosis. Understanding these complications is crucial for improving patient outcomes. CASE REPORT We present a case of a 47-year-old female patient admitted for seizures. Cranial magnetic resonance imaging revealed a right frontal lobe lesion. Following a right frontal lobe tumor resection for glioma, the patient experienced a series of complications. During surgery, significant elevations in blood pressure were noted, and a frontotemporal subdural hematoma was identified following bone flap removal, necessitating immediate evacuation. Although the initial hematoma was successfully cleared, a brainstem hematoma emerged later, leading the family to opt for conservative treatment instead of further surgery. Postoperative pathology confirmed an oligodendroglioma, isocitrate dehydrogenase-mutant, classified as WHO grade II. CONCLUSIONS This case underscores the rarity of simultaneous intraoperative subdural hematoma and postoperative brainstem hemorrhage in neurosurgery. The findings suggest a need for further investigation into preventive strategies, such as the use of lateral ventricle drains prior to craniotomy, to mitigate rapid intracranial pressure changes and associated hemorrhagic complications. Comprehensive research is warranted to explore effective interventions aimed at minimizing the risks of postoperative hemorrhage in high-risk surgical patients.