Kusano Yoshikazu, Horiuchi Tetsuyoshi, Seguchi Tatsuya, Kakizawa Yukinari, Tanaka Yuichiro, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Brain Inj. 2010;24(9):1118-21. doi: 10.3109/02699052.2010.490515.
Local brain herniation after removal of chronic subdural haematoma is extremely rare, especially in adult patients. This study reports a case of local brain herniation after partial membranectomy for organized chronic subdural haematoma.
A 77-year-old man presented with dysarthria and dysphasia caused by local brain herniation of the right frontal lobe through a defect of the inner membrane. The herniated brain was detected by magnetic resonance (MR) imaging. The patient underwent a craniotomy to release the herniated and strangulated brain, which were consistent with the MR imaging findings. The patient recovered fully within 1 month after surgery.
To date, five cases of brain herniation through the internal subdural membrane have been reported as complications of chronic subdural haematomas. All but one case occurred in the paediatric population. Urgent surgery should be performed, even if an adult patient suffers from local brain herniation, for preservation of brain function. This is the sixth reported case of brain herniation through a defect of the inner membrane and the second reported case in the adult population.
慢性硬膜下血肿清除术后发生局部脑疝极为罕见，尤其是在成年患者中。本研究报告了1例因机化性慢性硬膜下血肿行部分膜切除术后发生局部脑疝的病例。
一名77岁男性因右额叶通过内膜缺损处发生局部脑疝，出现构音障碍和言语困难。通过磁共振成像（MR）检测到疝出的脑组织。患者接受了开颅手术，以解除疝出并受压的脑组织，这与MR成像结果一致。患者术后1个月内完全康复。
迄今为止，已有5例硬膜下内膜处脑疝作为慢性硬膜下血肿的并发症被报道。除1例之外，其余病例均发生在儿童群体中。即使成年患者发生局部脑疝，为了保留脑功能也应进行紧急手术。这是第6例通过内膜缺损处发生脑疝的报道病例，也是成年人群中第2例报道病例。
