Chye Cien-Leong, Lin Kuo-Hsuan, Ou Chang-Hsien, Sun Cheuk-Kwan, Chang I-Wei, Liang Cheng-Loong
Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan.
Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan.
BMC Surg. 2015 May 10;15:60. doi: 10.1186/s12893-015-0045-x.
Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported. A skull metastasis of HCC with a tumor bleeding resulting in spontaneous subdural hematoma (SDH) is extremely unusual. We report the first case of acute spontaneous SDH in a 69-year-old woman who presented with acute onset of headache, because of tumor bleeding caused by skull metastasis of HCC.
A 69-year-old woman was referred to our hospital because of progressive headache, nausea, and vomiting for 3 days. Brain computed tomography (CT) performed in the emergency department (ED) revealed a left temporal SDH with a slight mass effect and a small left temporal bone erosion. Tri-phasic abdominal CT demonstrated a large right lobe liver tumor compatible with HCC. She experienced progressive deterioration of consciousness in the intensive care unit. Follow-up CT showed an enlargement of the SDH. An emergency craniotomy for hematoma evacuation and removal of skull tumor was performed. She regained consciousness and had no neurological deficits during the postoperative course. Pathological examination of the skull specimen indicated metastasis of a HCC.
Patients with acute SDH without a history of head injury are rarely encountered in the ED. Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH. Before an operation for SDH, the possibility of metastatic lesion of the skull should be considered in the surgical planning and the origin of malignancy should be sought.
肝细胞癌（HCC）的颅骨和颅内转移鲜有报道。HCC颅骨转移瘤出血导致自发性硬膜下血肿（SDH）极为罕见。我们报告首例69岁女性因HCC颅骨转移瘤出血导致急性头痛起病的急性自发性SDH病例。
一名69岁女性因进行性头痛、恶心和呕吐3天转诊至我院。急诊科行脑部计算机断层扫描（CT）显示左侧颞部SDH伴轻度占位效应及左侧颞骨轻度骨质侵蚀。腹部三相CT显示右叶有一个与HCC相符的大肝肿瘤。她在重症监护病房意识逐渐恶化。随访CT显示SDH增大。急诊行开颅血肿清除术及颅骨肿瘤切除术。术后她恢复意识，无神经功能缺损。颅骨标本病理检查提示HCC转移。
急诊科很少遇到无头部外伤史的急性SDH患者。出血性转移癌应作为急性自发性SDH的鉴别诊断之一。在进行SDH手术前，手术规划中应考虑颅骨转移瘤的可能性，并寻找恶性肿瘤的起源。
