Division of Neurosurgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8.
Neurosurg Rev. 2013 Apr;36(2):195-202; discussion 203. doi: 10.1007/s10143-012-0423-0. Epub 2012 Sep 2.
Rhabdomyolysis (RM) is a potentially fatal or disabling clinical syndrome resulting in muscle necrosis and leakage of muscle constituents into the blood. Lactic acidosis and more serious complications such as acute renal failure may occur in up to half of recognized cases, so accurate diagnosis is required. We present three cases in which RM occurred in patients undergoing neurosurgical procedures performed in the lateral position. A review of the literature is provided together with a framework for the prevention of this surgical complication. Three patients underwent neurosurgical procedures in the lateral position for left facial/glossopharyngeal neuralgia, for jugular foramen tumor, and for a petroclival meningioma, respectively. All patients were obese and all three showed massive postoperative elevation in creatine kinase (CK) levels characteristic of RM. Myoglobinuria was identified in two patients and all three showed hyperintensity of the hip gird muscles in the short tau inversion recovery sequence magnetic resonance imaging. All recovered spontaneously and none went on to develop renal failure. A literature review showed that RM has been rarely reported after neurosurgery. However, the duration of procedures of the cases of reported RM indicates that the prevalence of the condition is likely highly under-recognized in neurosurgery. This is particularly important given the rising obesity rates seen in many countries. Obese patients undergoing long neurosurgical procedures, particularly in the lateral position, should be suspected of RM and should be closely monitored for CK levels, myoglobinuria, and acidosis. We outline a framework of strategies for the prevention of the condition.
横纹肌溶解症（RM）是一种潜在致命或致残的临床综合征，导致肌肉坏死和肌肉成分渗漏到血液中。多达一半的确诊病例可能会发生酸中毒和更严重的并发症，如急性肾衰竭，因此需要准确诊断。我们报告了三例在侧卧位行神经外科手术的患者发生 RM 的病例。本文回顾了相关文献，并提出了预防这种手术并发症的框架。三例患者分别因左侧面部/舌咽神经痛、颈静脉孔肿瘤和岩斜脑膜瘤而行神经外科手术，均为侧卧位。所有患者均肥胖，且均出现肌酸激酶（CK）水平显著升高，符合 RM 的特征。两例患者出现肌红蛋白尿，所有患者的短tau 反转恢复序列磁共振成像均显示髋关节肌肉高信号。所有患者均自发恢复，无一例进展为肾衰竭。文献复习显示，RM 很少在神经外科手术后发生。然而，报告的 RM 病例的手术持续时间表明，这种情况在神经外科中的患病率很可能被严重低估。鉴于许多国家肥胖率的上升，这一点尤为重要。对于肥胖患者，尤其是接受长时间神经外科手术的患者，应怀疑 RM，并密切监测 CK 水平、肌红蛋白尿和酸中毒。我们提出了预防该疾病的策略框架。
