Huh Jisoon
Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
J Korean Neurosurg Soc. 2013 Jan;53(1):59-61. doi: 10.3340/jkns.2013.53.1.59. Epub 2013 Jan 31.
Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.
作者报告了一例罕见的急性颅内硬膜下和脑室内出血病例，其病因是脊柱手术期间脑脊液通过一个不明硬膜撕裂部位漏出导致颅内低压。最初的脑部计算机断层扫描图像显示急性出血合并先前存在的无症状慢性硬膜下出血。在右侧顶骨上钻了一个骨孔以引流颅内出血，并通过关闭硬脑膜切开部位诱导随后的脑脊液引流。在治疗通过不明硬膜损伤部位的脑脊液漏的各种方法中，一期修复和脊髓蛛网膜下腔引流是众所周知的治疗选择。在选择治疗方法之前，尤其是对于脊髓蛛网膜下腔引流，应进行脑部成像研究以诊断颅内出血。与其脊髓对应物类似的机制，颅骨脑脊液引流在先前的文章中未被提及，并且在需要引流颅内出血的特定情况下，可能是封闭不明硬膜撕裂的另一种治疗选择。
