常规颈椎手术后延迟性张力性脑积水和肺出血,无毛刺孔治疗成功。

IF 1.1 4区 医学 Q3 SURGERY Annals of the Royal College of Surgeons of England Pub Date : 2024-07-01 Epub Date: 2023-06-29 DOI:10.1308/rcsann.2023.0037
Y Lim, A Dahapute, A Clarke, M Hutton, W Selbi
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引用次数: 0

摘要

脊柱手术后的张力性脑积水(TP)非常罕见,英文文献中仅有几例报道。大多数 TP 病例都是在脊柱手术后迅速发生的。传统上,治疗 TP 的方法是通过钻孔来缓解颅内压力。然而,我们的病例突出显示了在常规颈椎手术后 1 个月出现 TP 和出血性肺炎的罕见延迟病例。据我们所知,这是第一例在脊柱手术后使用硬脊膜修补术和支持性护理治疗 TP 的病例。一名 75 岁的妇女因颈椎病接受常规颈椎减压和稳定术后出现 TP。她在首次手术后 1 个月再次就诊,伤口渗血,精神状态改变,入院后不久病情迅速恶化。结合她的影像学特征,医生决定紧急探查她的手术伤口。她完全康复,住院两周后出院。我们希望借此强调高度怀疑脑脊液漏的必要性和返回手术室修复潜在硬脊膜缺损的低门槛,并说明脊柱手术后的 TP 可以在没有毛刺孔的情况下成功治疗。
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Delayed tension pneumocephalus and pneumorrhacis after routine cervical spine surgery treated successfully without burr holes.

Tension pneumocephalus (TP) after spinal surgery is very rare with only a few cases reported in the English literature. Most cases of TP occur rapidly after spinal surgery. Traditionally, TP is managed using burr holes to relieve intracranial pressure. However, our case highlights a rare delayed presentation of TP and pneumorrhacis 1 month after routine cervical spine surgery. It is to our knowledge the first case of TP after spinal surgery to be treated using dural repair and supportive care. A 75-year-old woman presented with TP after having routine cervical decompression and stabilisation for cervical myelopathy. She re-presented 1 month after her initial operation with a leaking wound and altered mental status, which deteriorated rapidly shortly after admission. This, in combination with her radiographic features, influenced the decision to explore her surgical wound emergently. She made a full recovery and was discharged after 2 weeks in hospital. We hope to emphasise the need for a high index of suspicion for cerebrospinal fluid leaks and the low threshold to return to theatre to repair a potential dural defect, as well as illustrate that TP after spinal surgery can be treated successfully without burr holes.

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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
316
期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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