Chin Kingsley R, Seale Jason, Butron Veronica, Cumming Vanessa
Charles E. Schmidt College of Medicine, Florida Atlantic University and Institute for Modern and Innovative Surgery (iMIS), 1100 W. Oakland Park Boulevard, Suite No. 3, Fort Lauderdale, FL 33311, USA.
Case Rep Med. 2013;2013:590639. doi: 10.1155/2013/590639. Epub 2013 Mar 7.
Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF). We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4-6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200 mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms.
单纯血肿是颈椎前路减压融合术（ACDF）后报道的最常见血管并发症。我们呈现此病例以报告在一次无并发症的C4 - 6 ACDF术后发生的颈部血肿并发同侧颈动脉血栓形成和失语。这是一例65岁女性患者，她接受了C4 - 5和C6 - 7节段的翻修融合术，术后并发颈部血肿和颈动脉血栓形成。报告了患者的病史、临床检查、影像学表现及治疗情况。翻修融合术被认为是常规操作。大约八小时后，从术后颈部血肿中抽出200毫升血液。在抽出血肿数小时后，患者出现无反应和定向障碍。脑部计算机断层扫描和磁共振成像结果正常，但磁共振血管造影显示左侧颈动脉完全闭塞。进行了血栓切除术，患者出院时无残留神经功能缺损。在最近的随访中，她颈部功能完全正常且无症状。我们建议，在抽出颈部血肿后，用磁共振血管造影（MRA）或脑血管造影对颈动脉进行评估，因为这可能在患者出现症状之前就发现血栓。
