Contralateral cerebellar infarction after aneurysmal clipping with pterional craniotomy: report of two cases]

A 77-year-old woman underwent right fronto-temporal craniotomy for a right ruptured IC-PC aneurysm (case 1), and a 44-year-old woman underwent right fronto-temporal craniotomy for a right ruptured BASCA aneurysm (case 2). They were clipped completely without any troubles during surgery. But postoperative CT scan demonstrated contralateral cerebellar infarction. We recognized left-hand tremor as a neurological deficit caused by cerebellar infarction in case I. Concerning the mechanism of contralateral cerebellar infarction after pterional craniotomy, we think that it could be; -1) changing of venous blood flow by overdrainage of cerebrospinal fluid, 2) destruction of the bridging vein because of cerebral transformation with rapid decompression, 3) ischemia caused by brain retraction and compression during operation, 4) hypertension or hypoxia during operation, 5) crossed cerebellar diaschosis, and so on. In our 2 cases, we believe that perioperative CSF overdrainage caused the contralateral cerebellar infarction or CCD. To avoid this kind of infarction, we should try to take more protective and careful procedures as well as closer perioperative management.