Kim Myoung Soo, Lee Chae Heuck, Lee Seung Jun, Rhee Jong Joo
Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Jung-Gu, Seoul, Korea.
Neurol Med Chir (Tokyo). 2007 Jan;47(1):22-5. doi: 10.2176/nmc.47.22.
Four patients presented with rare spinal subdural hematoma (SDH) occurring after intracranial aneurysm surgery and manifesting as postoperative back pain. Magnetic resonance imaging performed from 4 to 11 days after the operation showed acute or subacute thoracolumbar SDH. No patient had risk factors for bleeding at this site (e.g., lumbar puncture, coagulation abnormality). Overdrainage of the cerebrospinal fluid (CSF) was performed for brain retraction during the operation in all four cases. Computed tomography performed during the postoperative period showed a suspicious tentorial subdural hemorrhage in Case 1 and an interhemispheric subdural hemorrhage in Case 3. All four patients received conservative management and their lumbago improved. We hypothesize that CSF hypotension due to overdrainage of CSF and downward migration of intracranial SDH under the influence of gravity were involved in the formation of spinal SDH.
4例患者在颅内动脉瘤手术后出现罕见的脊髓硬膜下血肿（SDH），表现为术后背痛。术后4至11天进行的磁共振成像显示急性或亚急性胸腰段SDH。所有患者均无该部位出血的危险因素（如腰椎穿刺、凝血异常）。所有4例患者在手术期间均因脑牵拉进行了脑脊液（CSF）过度引流。术后计算机断层扫描显示病例1有可疑的小脑幕硬膜下出血，病例3有大脑半球间硬膜下出血。所有4例患者均接受了保守治疗，腰痛症状改善。我们推测，CSF过度引流导致的CSF低血压以及颅内SDH在重力影响下向下迁移与脊髓SDH的形成有关。
