Murata Takahiro, Shigeta Hiroaki, Horiuchi Tetsuyoshi, Sakai Keiichi, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Neurosurg Pediatr. 2010 Feb;5(2):210-2. doi: 10.3171/2009.9.PEDS09391.
Subdural hematoma (SDH) is a well-known sequela of ventriculoperitoneal shunt insertion for hydrocephalus, usually spreads out over the cerebral convexity, and appears as a crescent-shaped lesion on imaging. The authors report the rare case of an infant with a globular SDH, which MR imaging revealed as a round mass lesion. A 13-month-old girl with a history of severe congenital hydrocephalus associated with myeloschisis underwent ventriculoperitoneal shunt placement after repair of myeloschisis and developed convulsive seizure. Magnetic resonance imaging showed a large subdural round mass with a lesion like a pedestal in the left parietal region, suggesting a globular SDH surrounded by a thin cerebral mantle. Because of the seizures and because the hematoma did not respond to a change in valve pressure, the patient underwent a craniotomy to remove the hematoma and to resect the thick outer membranes of multiple layers. Postoperative MR imaging demonstrated the disappearance of the SDH, and no additional shunt complication was observed during a long follow-up period. To the authors' knowledge, this is the first report of a patient with globular SDH published in the literature. The authors postulate that the globular SDH was caused by the thin cerebral mantle associated with severe craniocerebral disproportion, and they discuss the possible mechanisms for this unique formation.
硬膜下血肿（SDH）是脑积水脑室腹腔分流术插入术后一种众所周知的后遗症，通常扩散至脑凸面，在影像学上表现为新月形病变。作者报告了一例罕见的婴儿球形SDH病例，磁共振成像显示为圆形肿块病变。一名13个月大的女孩，有严重先天性脑积水合并脊髓脊膜膨出病史，在脊髓脊膜膨出修复术后接受了脑室腹腔分流术，并出现惊厥发作。磁共振成像显示左顶叶区域有一个大的硬膜下圆形肿块，有一个类似基座的病变，提示为被薄脑皮层包裹的球形SDH。由于惊厥发作且血肿对瓣膜压力变化无反应，该患者接受了开颅手术以清除血肿并切除多层增厚的外层膜。术后磁共振成像显示SDH消失，在长期随访期间未观察到其他分流并发症。据作者所知，这是文献中首次报道的球形SDH患者。作者推测球形SDH是由与严重颅脑比例失调相关的薄脑皮层引起的，并讨论了这种独特形成的可能机制。
