Nathoo N, Nadvi S S, Royston D, van Dellen J R, Rana M, Narotam P K, Gouws E
Department of Neurosurgery, University of Natal Medical School, Wentworth Hospital and Medical Research Council, Durban, South Africa.
East Afr Med J. 2000 Jul;77(7):359-63.
Previous studies have demonstrated that rhinogenic subdural empyema (SDE) generally has a good prognosis. Most patients are admitted with an altered level of consciousness or significant neurological deficit, but eventually have a good outcome. It is well known that intra-operative brain swelling may occur with subdural empyema.
To define cerebral blood flow (CBF) dynamics and determine the role of cerebral hyperaemia, if any, in intracranial SDE.
CBF dynamics were assessed in five patients (mean age 13.2 +/- 2.2 years) with unilateral rhinogenic convexity SDE documented on computer tomography (CT). Regional cortical blood flow (rCBF) was measured using a thermo-coupled sensor placed on the cortex at the time of surgery. Dynamic CT scans were performed to assess cerebral blood volume (CBV) quantitatively, while transcranial Doppler ultrasonography (TCD) was used to measure cerebral blood flow velocities (CBF velocities) both pre- and post-operatively for 21 days. The opposite 'normal' hemisphere served as a control for each patient.
Post-operative rCBF and CBF velocities in the pathological hemisphere progressively increased to plateau at 96 hours. Cerebral blood volume was increased bilaterally, but to a greater extent in the pathological hemisphere and more so in grey than white matter. These haemodynamic changes, though clinically significant did not reach statistical significance (p>0.05).
Our results suggest that the accompanying brain swelling in rhinogenic SDE is a complex event, with reactive cerebral hyperaemia possibly playing neuroprotective role. Furthermore, unilateral convexity empyema causes bilateral cerebral haemodynamic changes. Future studies are necessary to define the aetiology of brain swelling in intracranial SDE.
既往研究表明，鼻源性硬膜下积脓（SDE）通常预后良好。大多数患者入院时意识水平改变或有明显神经功能缺损，但最终预后良好。众所周知，硬膜下积脓术中可能会发生脑肿胀。
确定脑血流量（CBF）动力学，并确定脑充血在颅内SDE中（若存在）的作用。
对5例（平均年龄13.2±2.2岁）经计算机断层扫描（CT）证实为单侧鼻源性凸面SDE的患者进行CBF动力学评估。手术时使用置于皮质的热电偶传感器测量局部皮质血流量（rCBF）。进行动态CT扫描以定量评估脑血容量（CBV），同时使用经颅多普勒超声（TCD）在术前和术后21天测量脑血流速度（CBF速度）。对每位患者而言，对侧“正常”半球作为对照。
术后患侧半球的rCBF和CBF速度在96小时时逐渐增加至平稳状态。双侧脑血容量均增加，但患侧半球增加程度更大，灰质比白质增加更明显。这些血流动力学变化虽具有临床意义，但未达到统计学显著性（p>0.05）。
我们的结果表明，鼻源性SDE伴发的脑肿胀是一个复杂事件，反应性脑充血可能发挥神经保护作用。此外，单侧凸面积脓会引起双侧脑血流动力学变化。有必要开展进一步研究以明确颅内SDE脑肿胀的病因。
