Katedra i Klinika Neurochirurgii, Akademicki Szpital Kliniczny AM we Wrocławiu, ul. Borowska 213, 50-556 Wrocław.
Neurol Neurochir Pol. 2011 Sep-Oct;45(5):500-4. doi: 10.1016/s0028-3843(14)60319-4.
Bilateral chronic subdural haemorrhage accompanying meningioma is a very rare clinical condition. We present a case of a 69-year-old female patient with large meningioma completely obliterating the posterior third part of the superior sagittal sinus with accompanying bilateral chronic subdural haematomas. Three anatomical zones of venous collateral circulation were revealed by the preoperative digital subtraction angiography. The tumour and haematomas were removed completely with no major complications. The most likely pathomechanism of the development of bilateral chronic subdural haematomas was venous hypertension caused by an occlusion of major cerebral venous trunks. As a result of a minor thrombotic incident or insignificant head injury, the distended veins of collateral circulation that were volumetrically burdened could have been damaged. Patients with large tumours occluding the superior sagittal sinus, who did not qualify for or refused surgery, should be carefully monitored clinically and neuroradiologically because of possibly increased risk of an intracranial haemorrhage.
脑膜瘤伴双侧慢性硬脑膜下血肿是一种非常罕见的临床情况。我们报告一例 69 岁女性患者，患有巨大脑膜瘤，完全闭塞上矢状窦后三分之一段，伴有双侧慢性硬脑膜下血肿。术前数字减影血管造影显示有三个静脉侧支循环解剖区域。肿瘤和血肿被完全切除，没有出现重大并发症。双侧慢性硬脑膜下血肿发展的最可能的病理机制是大脑大静脉主干闭塞引起的静脉高压。由于小的血栓事件或轻微的头部外伤，体积负荷过重的侧支循环扩张静脉可能受损。对于那些不符合手术条件或拒绝手术的大型肿瘤阻塞上矢状窦的患者，由于颅内出血风险可能增加，应进行临床和神经影像学的仔细监测。
