Bulleid Lindsey S, Hughes Tom, Bhatti Imran, Leach Paul A
Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
Department of Neurology, University Hospital of Wales, Cardiff, UK.
Childs Nerv Syst. 2016 May;32(5):897-9. doi: 10.1007/s00381-015-2928-7. Epub 2015 Oct 7.
We describe a case of a patient who suffered low-pressure headaches secondary to absorption of cerebrospinal fluid into the venous system of the diploic space following a foramen magnum decompression. This case is important as it describes a physiologically plausible but previously undescribed complication of a common surgical intervention.
A nine-year-old boy underwent a foramen magnum decompression for a Chiari malformation (Type I). Five years after his initial decompression, his original symptoms returned and he underwent further decompression with short-term relief of symptoms. He then began to describe low-pressure headaches. Comprehensive investigations revealed a small posterior pseudomeningocoele that had extended into the diploic space at the site of the previous surgery to the occipital bone. It was postulated that the diploic space may be acting as an additional site for reabsorption of his CSF, and as a result of this, he was experiencing consistently low-pressure symptoms. His symptoms have completely resolved following surgical intervention to seal the site of communication with the diploic space.
We review recent literature that supports this theory through an understanding of the anatomy of the diploic venous system and also its physiological behaviour as demonstrated in recent cadaveric and porcine studies.
我们描述了一例患者，该患者在枕骨大孔减压术后因脑脊液被吸收进入板障静脉系统而出现低压性头痛。该病例很重要，因为它描述了一种常见外科手术干预中生理上看似合理但此前未被描述的并发症。
一名9岁男孩因Chiari畸形（I型）接受了枕骨大孔减压术。初次减压5年后，他原来的症状复发，再次接受减压后症状得到短期缓解。随后他开始诉说低压性头痛。全面检查发现一个小的后假性脑脊膜膨出，已延伸至先前枕骨手术部位的板障间隙。据推测，板障间隙可能成为其脑脊液再吸收的额外部位，因此，他持续出现低压症状。在采取手术干预封闭与板障间隙的连通部位后，他的症状已完全缓解。
我们回顾了近期文献，这些文献通过对板障静脉系统解剖结构以及近期尸体和猪研究中所展示的其生理行为的理解来支持这一理论。
