Shimizu S, Tachibana S, Maezawa H, Fujii K, Kan S
Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa.
Neurol Med Chir (Tokyo). 1999 Apr;39(4):299-301. doi: 10.2176/nmc.39.299.
A 52-year-old female complained of lumbago and weakness in the lower extremities 6 days after craniotomy for clipping an aneurysm. Neurological examination revealed symptoms consistent with lumbosacral cauda equina compression. The symptoms affecting the lower extremities spontaneously disappeared within 3 days. Magnetic resonance (MR) imaging 10 days after the operation demonstrated a lumbar spinal subdural hematoma (SSH). She had no risk factor for bleeding at this site, the symptoms appeared after she began to walk, and MR imaging suggested the SSH was subacute. Therefore, the SSH was probably due to downward movement of blood from the cranial subdural space under the influence of gravity. SSH as a complication of cranial surgery is rare, but should be considered if a patient develops symptoms consistent with a lumbar SSH after craniotomy.
一名52岁女性在因夹闭动脉瘤行开颅手术后6天,出现腰痛及下肢无力症状。神经系统检查发现症状与腰骶部马尾神经受压相符。影响下肢的症状在3天内自行消失。术后10天的磁共振成像显示腰椎硬脊膜下血肿(SSH)。她在该部位没有出血危险因素,症状在开始行走后出现,磁共振成像提示SSH为亚急性。因此,SSH可能是由于重力影响下血液从颅硬脑膜下腔向下移动所致。作为颅脑手术并发症的SSH很少见,但如果患者在开颅术后出现与腰椎SSH相符的症状,应予以考虑。