Mangubat Erwin, Sani Sepehr
Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
Neurologist. 2015 May;19(5):135-9. doi: 10.1097/NRL.0000000000000024.
Cranioplasty procedures are performed usually after devastating neurological injuries requiring craniectomies. Although relatively safe, global intracerebral infarction is a poorly understood, and most often, lethal complication after cranioplasty. We report here one such case with a thorough literature review with insight as to possible etiologies of this injury.
A 14-year-old girl underwent a left-sided decompressive hemicraniectomy for treatment of a subdural hematoma and cerebral edema. The patient's neurological condition eventually improved and she presented for cranioplasty repair of the defect 83 days after her initial operation. Six hours after an uneventful procedure, the patient's neurological examination declined. Immediate CT scan revealed global edema. Despite all treatment measures, the patient progressed to global ischemia and brain death and expired.
Although global intracerebral infarction after cranioplasty is extremely rare, the concepts of vessel injury, venous stasis, and reperfusion into dysfunctional cerebral tissue after cranioplasty should be considered when evaluating the risk of this procedure.
颅骨修补手术通常在因严重神经损伤而进行颅骨切除术后进行。尽管相对安全，但全脑梗死是颅骨修补术后一种了解甚少且最常见的致命并发症。我们在此报告这样一例病例，并对该损伤可能的病因进行全面的文献综述。
一名14岁女孩因治疗硬膜下血肿和脑水肿接受了左侧减压性颅骨切除术。患者的神经状况最终有所改善，在初次手术后83天前来进行颅骨缺损修补术。手术过程顺利，术后6小时，患者的神经检查结果变差。立即进行的CT扫描显示全脑水肿。尽管采取了所有治疗措施，患者仍进展为全脑缺血和脑死亡，最终死亡。
尽管颅骨修补术后全脑梗死极为罕见，但在评估该手术风险时，应考虑血管损伤、静脉淤滞以及颅骨修补术后再灌注进入功能失调脑组织的概念。
