Agrawal Deepak, Naik Vikas
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
J Pediatr Neurosci. 2015 Jan-Mar;10(1):5-8. doi: 10.4103/1817-1745.154314.
Postoperative cerebral venous infarction (POCVI) is not an uncommon complication in cranial surgeries. However, literature is sparse on the epidemiology and management of postoperative venous infarcts.
The aim was to study the incidence and clinico-radiological course of POCVI in patients in a tertiary level neurosurgical unit and compare the outcome between pediatric and adult patients following POCVI.
In this prospective study carried out over an 8 month period, consecutive patients undergoing elective major cranial surgeries were monitored neurologically and with serial computed tomography (CT) of the head for POCVI in the postoperative period. All patients had at least one CT head done within 24 hours of surgery. Diagnosis of hemorrhagic POCVI was based on the presence of subcortical, multifocal hyperdensities with irregular margins and or low density areas in the perioperative fields. Nonhemorrhagic POCVI was diagnosed if CT showed a localized hypodensity poorly demarcated in the subcortical white matter with/without mass effect, along with the presence of fresh neurological deficits.
A total of 376 patients were enrolled in the study period. Of these, 26 (7%) developed POCVI. The male: female ratio was 1.2:1 and age ranged from 6 to 68 years with 12 (46%) being under the age of 18 years. Sixteen (61%) patients developed hemorrhagic POCVI and 10 (39%) patients developed nonhemorrhagic POCVI. The mean time to POCVI detection was 72 hours (range 24-144 hours). Seventeen (66%) patients were managed conservatively, and nine (34%) patients underwent decompressive craniectomy as an additional procedure for management of POCVI. In five patients (all with hemorrhagic POCVI), the infarction was an incidental finding. Of the 21 patients with symptomatic POCVI, 13 (61.9%) patients improved neurologically and were discharged with residual deficits. Two (9.5%) showed no neurological improvement till discharge, and 6 (28.5%) died during the hospital stay following POCVI.
Children constitute a significant population (46% in our study) of the patients who develop POCVI with poor outcome similar to that seen in adult patients.
术后脑静脉梗死（POCVI）是颅脑手术中一种并不罕见的并发症。然而，关于术后静脉梗死的流行病学和治疗的文献较少。
本研究旨在探讨三级神经外科单位患者中POCVI的发病率及临床影像学过程，并比较POCVI患儿与成人患者的预后。
在这项为期8个月的前瞻性研究中，对接受择期大型颅脑手术的连续患者在术后进行神经功能监测，并通过头颅计算机断层扫描（CT）连续检查是否发生POCVI。所有患者在术后24小时内至少进行了一次头颅CT检查。出血性POCVI的诊断依据是皮质下存在多灶性高密度影，边缘不规则，和/或围手术期区域出现低密度区。如果CT显示皮质下白质有界限不清的局限性低密度影，伴有或不伴有占位效应，同时出现新的神经功能缺损，则诊断为非出血性POCVI。
研究期间共纳入376例患者。其中，26例（7%）发生POCVI。男女比例为1.2:1，年龄范围为6至68岁，12例（46%）年龄在18岁以下。16例（61%）患者发生出血性POCVI，10例（39%）患者发生非出血性POCVI。检测到POCVI的平均时间为72小时（范围24 - 144小时）。17例（66%）患者接受保守治疗，9例（34%）患者接受去骨瓣减压术作为POCVI的额外治疗手段。5例患者（均为出血性POCVI）的梗死为偶然发现。在21例有症状的POCVI患者中，13例（61.9%）神经功能改善并遗留神经功能缺损出院。2例（9.5%）直至出院时神经功能无改善,6例（28.5%）在POCVI后住院期间死亡。
儿童是发生POCVI的重要人群（在我们的研究中占46%），其预后与成人患者相似，较差。
