Subarachnoid Hemorrhage and Acute Hydrocephalus as a Complication of C1 Lateral Mass Screws

Study Design. Case report. Objective. To present a previously unreported complication of subarachnoid hemorrhage and hydrocephalus after C1 lateral mass screw insertion. To inform spine specialists of this potential postoperative complication. Summary of Background Data. Damage to the carotid artery, vertebral artery, hypoglossal nerve and dural tears are all recognized complications. Acute hydrocephalus as a result of subarachnoid hemorrhage is not previously reported. Methods. A 63-year-old female with a traumatic C1 ring and C2 peg fracture underwent C1-C2 fixation. During insertion of the C1 lateral mass screws there was significant hemorrhage from the C1-C2 venous plexus. Three days postoperatively, she developed headache, confusion, and became drowsy. Results. Computed tomographic scan of the brain revealed hydrocephalus and intraventricular blood that was managed with an external ventricular drain. Conclusion. The case of acute hydrocephalus due to intraventricular hemorrhage from C1 lateral mass screw placement has not previously been reported. Surgeons performing the procedure should consider the diagnosis if patients display signs of raised intracranial pressure postoperatively.