Central Herniation Induced by Craniotomy Prompting Air Replacement for Subdural Fluid Collection Due to Cerebrospinal Fluid Hypovolemia.
Central Herniation Induced by Craniotomy Prompting Air Replacement for Subdural Fluid Collection Due to Cerebrospinal Fluid Hypovolemia.
复制标题
开颅手术引起的中枢性疝气提示空气置换，以收集由于脑脊液血容量不足而导致的硬膜下积液。
DOI：
10.1016/j.wneu.2018.06.059
复制
发表时间：
2018
影响因子：
2
通讯作者：
Yasushi Motoyama
中科院分区：
文献类型：
--
作者：
Takahide Haku;Yasushi Motoyama
慢性硬膜下血肿（CSDH）常伴有脑脊液（CSF）血容量减少.据报道，许多因CSF血容量不足而接受钻孔手术治疗的CSDH病例出现反常恶化。然而，CSDH手术后恶化的机制和病理，由于CSF血容量不足仍然ambiguous.Case Description我们在此报告一个62岁的男子与步态障碍，由于硬膜下积液（SDFC）谁接受钻孔冲洗和额外的开颅手术，其中术后恶化导致快速进展的中央疝与大量的空气积累。硬膜外血液补片与盐水输注在胸椎终于解决中央herniation.ConclusionSDFC恶化手术后从未报道过。SDFC与CSF有交通联系，与成熟的CSDH不同，后者由封闭的空腔和新膜包绕而成。在由于硬脊膜撕裂导致CSF血容量不足的情况下，打开颅骨可促使CSF空间中的空气置换，这可能代表由浮力快速丧失引起的中央疝的实质性风险。
BackgroundChronic subdural hematoma (CSDH) often occurs in association with cerebrospinal fluid (CSF) hypovolemia. Many cases with CSDH due to CSF hypovolemia and treated by burr hole surgery have been reported to present with paradoxical deterioration. However, the mechanisms and pathology of deterioration after surgery for CSDH due to CSF hypovolemia remain obscure.Case DescriptionWe report herein a 62-year-old man with gait disturbance due to subdural fluid collection (SDFC) who underwent burr hole irrigation and additional craniotomy, in which postoperative deterioration resulted from rapidly progressing central herniation with a large amount of air accumulation. Epidural blood patch with saline infusion in the thoracic spine finally resolved central herniation.ConclusionSDFC deteriorating after surgery has never been reported. SDFC has communication with CSF differing from mature CSDH composed of closed cavity surrounded by neomembrane. Under situations of CSF hypovolemia due to spinal dural tear, opening the cranium can prompt air replacement in the CSF space, which might represent a substantial risk for central herniation caused by a rapid loss of buoyancy force.