Seinfeld Joshua, Sawyer Michael, Rabb Craig H
Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204-4507, USA.
Neurosurgery. 2007 Sep;61(3 Suppl):E175; discussion E175. doi: 10.1227/01.neu.0000289731.27706.af.
Death resulting from paradoxical cerebral herniation after the removal of cerebrospinal fluid from the lumbar cistern in a patient with a large craniectomy defect has recently been described. We report a case of successful treatment of this process by placement of a lumbar epidural blood patch.
A 19-year-old man underwent a large craniectomy after a motorcycle-related trauma. He subsequently developed a progressive, large subgaleal fluid collection with very mild ventriculomegaly. A lumbar drain was placed, which resulted in paradoxical cerebral herniation.
The patient was placed in the Trendelenberg position, and a lumbar epidural blood patch was placed. The next morning, there was complete resolution of the midline shift and restoration of visible basal cisterns. The patient has made an excellent recovery.
We conclude that paradoxical cerebral herniation can be quickly reversed and successfully treated by placement of a lumbar epidural blood patch.
近期有报道称，一名颅骨切除缺损较大的患者在腰大池脑脊液引流后发生反常性脑疝死亡。我们报告一例通过放置腰段硬膜外血补丁成功治疗该过程的病例。
一名19岁男性在摩托车相关创伤后接受了大骨瓣开颅手术。随后，他逐渐出现巨大的帽状腱膜下积液，并伴有非常轻微的脑室扩大。放置了腰大池引流管，结果导致了反常性脑疝。
患者置于头低脚高位，并放置了腰段硬膜外血补丁。第二天早晨，中线移位完全消失，基底池可见恢复。患者恢复良好。
我们得出结论，通过放置腰段硬膜外血补丁可迅速逆转并成功治疗反常性脑疝。
