Martínez-Lage Juan F, López-Guerrero Antonio L, Piqueras Claudio, Almagro María-José, Gilabert Amparo
Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, 30120, Spain,
Childs Nerv Syst. 2015 Jun;31(6):837-42. doi: 10.1007/s00381-015-2682-x. Epub 2015 Mar 26.
Intracranial cerebrospinal fluid (CSF) volume depletion causes diverse clinical syndromes most of them constituting the manifestations of decreased intracranial pressure. Subdural collections or chronic subdural hematomas are the best-known consequences of persistent CSF leaks, especially in overshunted hydrocephalus. Continuous CSF escape also occurs after lumbar puncture, spinal anesthesia, and diverse spinal surgeries.
A 6-year-old boy submitted to reoperation of spinal cord compression due to partial sacral agenesis complained of postoperative orthostatic headaches and vomiting initially attributed to CSF hypotension. There were neither subcutaneous fluid accumulations nor CSF leakage from the wound. The child was treated with strict bed rest and intravenous hydration for 5 days. On reassuming orthostatism, the patient had syncope but did not hit his head. A cranial computerized tomography scan showed an acute subdural hematoma that was managed conservatively with total recovery.
A review of current literature showed scanty reports of acute intracranial bleeding occurring after CSF depletion following spinal surgical procedures. To our knowledge, our reported patient represents the second case of this occurrence following surgery for closed spinal dysraphism in a child. The authors briefly review documented instances of acute subdural hematoma following spinal procedures, advise about its diagnosis, and suggest preventive measures.
颅内脑脊液（CSF）容量减少会引发多种临床综合征，其中大多数是颅内压降低的表现。硬膜下积液或慢性硬膜下血肿是持续性脑脊液漏最常见的后果，尤其是在分流过度的脑积水患者中。腰椎穿刺、脊髓麻醉及各种脊柱手术后也会持续出现脑脊液外漏。
一名6岁男孩因部分骶骨发育不全接受脊髓压迫症再次手术，术后出现体位性头痛和呕吐，最初归因于脑脊液低压。伤口既无皮下积液，也无脑脊液漏出。该患儿接受了5天的严格卧床休息和静脉补液治疗。重新站立时，患儿发生晕厥，但未头部受伤。头颅计算机断层扫描显示急性硬膜下血肿，经保守治疗后完全康复。
对当前文献的回顾显示，脊柱手术后脑脊液减少后发生急性颅内出血的报道很少。据我们所知，我们报道的该例患者是儿童闭合性脊柱裂手术后发生这种情况的第二例。作者简要回顾了脊柱手术后急性硬膜下血肿的记录病例，给出了诊断建议，并提出了预防措施。
