Abstract
BACKGROUND: Remote supratentorial hemorrhage (RSH) is a rare condition following elective craniotomy, leading to severe morbidity. This report aims to analyze the incidence and possible pathophysiology of RSH in patients undergoing elective craniotomy and to present the case of RSH following left frontal lobectomy for recurrent oligodendroglioma. OBSERVATIONS: The authors present the case of a 56-year-old male who presented with a recurrence 20 years after resection of a left frontal oligodendroglioma (WHO grade 2). He presented with new-onset expressive dysphasia and right-sided weakness. MRI revealed a recurrent mass in the left frontal lobe. The patient was scheduled for a left frontal lobectomy. Surprisingly, 2 hours after the operation, the patient became neurologically worse and developed general tonic-clonic seizures. Subsequent head CT showed bilateral temporal hemorrhages. No surgical intervention was undertaken, and the patient was discharged from the hospital 2 weeks later in stable condition with near-complete neurological recovery. LESSONS: RSH is a rare critical postoperative complication that requires careful monitoring. Early detection and intervention can improve outcomes, emphasizing the need for further research on its etiologies, risk factors, and management strategies. https://thejns.org/doi/10.3171/CASE2514.