Aoyama Takeshi, Hida Kazutoshi
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido.
Neurol Med Chir (Tokyo). 2010;50(2):165-7. doi: 10.2176/nmc.50.165.
A 69-year-old man presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The aneurysm neck was clipped and a lumbar drainage tube was inserted for cerebrospinal fluid drainage. However, the tube was accidentally cut during removal and a fragment remained in the spinal canal. A subarachnoid, subcutaneous abscess appeared 7 days later, which was treated with antibiotics. He noted numbness of his left leg after 6 months, and gait disturbance manifested 3 months later. T(1)-weighted magnetic resonance (MR) imaging disclosed a well-enhanced extramedullary mass at the T9-10 intervertebral level, and T(2)-weighted MR imaging showed moderate edema around the peri-lesional spinal cord. The mass containing a drainage tube fragment was surgically removed. Histological examination confirmed granuloma due to chronic infection. This case suggests that retained tube fragments should be removed surgically, especially in the presence of infectious complications.
一名69岁男性因前交通动脉动脉瘤破裂导致蛛网膜下腔出血。对动脉瘤颈部进行了夹闭，并插入了一根腰大池引流管用于脑脊液引流。然而，在拔管过程中引流管意外被切断，有一个碎片残留在椎管内。7天后出现了蛛网膜下腔及皮下脓肿，使用抗生素进行了治疗。6个月后他感到左腿麻木，3个月后出现步态障碍。T1加权磁共振成像显示在T9 - 10椎间水平有一个强化良好的髓外肿块，T2加权磁共振成像显示病变周围脊髓有中度水肿。包含引流管碎片的肿块被手术切除。组织学检查证实为慢性感染所致的肉芽肿。该病例提示，尤其是在存在感染性并发症的情况下，应通过手术取出残留的管碎片。
