Reoperation-requiring postoperative intracranial haemorrhage after posterior fossa craniotomy: Retrospective case-series

Studies report rates of treatment-requiring postoperative intracranial haemorrhage after craniotomy around 1–2%, but do not distinguish between supratentorial and posterior fossa operations. Reports about intracranial haemorrhages’ temporal occurrence show conflicting results. Recommendations for duration of postoperative monitoring vary. To determine the rate, temporal pattern and clinical presentation of reoperation-requiring postoperative intracranial posterior fossa haemorrhage. This retrospective case-series identified cases operated with posterior fossa craniotomy or craniectomy between January 1, 2007 and December 31, 2021 by an electronic search in the patient administrative database, and collected data about patient- and treatment-characteristics, postoperative monitoring, and the occurrence of haemorrhagic and other serious postoperative complications. We included 62 (n = 34, 55% women) cases with mean age 48 (interquartile range 50) years operated for tumours (n = 34, 55%), Chiari malformations (n = 18, 29%), ischemic stroke (n = 6, 10%) and other lesions (n = 3, 5%). One (2%) 66-year-old woman who was a daily smoker operated with decompressive craniectomy and infarct resection, developed a reoperation-requiring postoperative intracranial haemorrhage after 25.5 h. In four (6%) cases, other serious complications requiring reoperation or transfer from the post anaesthesia care unit or regular bed wards to the intensive care unit occurred after 0.5, 6, 9 and 54 h, respectively. Treatment-requiring postoperative intracranial haemorrhage and other serious complications after posterior fossa craniotomies occur over a wide timespan and are difficult to capture with a standardized postoperative monitoring time. This indicates that the duration of monitoring should be individualized based on assessment of risk factors. •Reports about the frequency and temporal occurrence of postoperative intracranial haemorrhages in the posterior fossa show conflicting results.•Recommendations for duration of postoperative monitoring therefore vary.•We reviewed 62 cases operated with craniotomy or craniectomy in the posterior fossa.•One developed a reoperation-requiring intracranial haemorrhage after 25.5 h.•The duration of monitoring should be based on individualized risk assessment.