Guan Jian, Spivak Emily S, Wilkerson Christopher, Park Min S
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Division of Infectious Disease, Department of Internal Medicine, University of Utah Medical Center, Salt Lake City, Utah, USA.
World Neurosurg. 2017 Jan;97:749.e1-749.e6. doi: 10.1016/j.wneu.2016.10.133. Epub 2016 Nov 5.
Multimodal intracranial monitoring is becoming an increasingly common tool in the management of patients with traumatic brain injury. Although numerous reports detailing the benefits of such advanced monitoring exist in the literature, there is minimal discussion of the possible complications that may arise in this patient population.
We report the case of a 32-year-old patient who had been assaulted and presented initially at an outside facility with a Glasgow Coma Scale score of 8. After transfer to our hospital, his Glasgow Coma Scale score was noted at 7T and multimodal monitoring with the Integra Licox brain tissue oxygen monitor and the Hemedex Bowman perfusion monitor was implemented, along with an external ventricular drain when a standard intracranial pressure monitor indicated increasing intracranial pressure. The patient's intracranial pressure normalized but he did require a course of antibiotics during this time for a fever and methicillin-resistant Staphylococcus aureus. The patient subsequently developed multifocal subdural empyemas requiring surgical evacuation. Postoperatively, the patient's intraoperative cultures remained without bacterial growth, likely related to the 2-week broad-spectrum antibiotic use.
To our knowledge, this is the first reported incidence of a subdural empyema developing in this setting. Although the safety profile of multimodal intracranial modeling is excellent, with increasing numbers of invasive bedside procedures, neurosurgeons must remain acutely vigilant for the development of infectious complications.
多模态颅内监测正日益成为创伤性脑损伤患者管理中常用的工具。尽管文献中有大量详细描述这种先进监测益处的报告，但对于该患者群体可能出现的并发症讨论极少。
我们报告一例32岁患者，其遭人袭击，最初在外部医疗机构就诊时格拉斯哥昏迷量表评分为8分。转至我院后，其格拉斯哥昏迷量表评分为7分，遂采用Integra Licox脑组织氧监测仪和Hemedex Bowman灌注监测仪进行多模态监测，并在标准颅内压监测仪显示颅内压升高时置入了外置脑室引流管。患者颅内压恢复正常，但在此期间因发热及耐甲氧西林金黄色葡萄球菌感染接受了一个疗程的抗生素治疗。该患者随后发生多灶性硬膜下积脓，需要手术引流。术后，患者术中培养结果无细菌生长，这可能与使用了2周的广谱抗生素有关。
据我们所知，这是首次报道在这种情况下发生硬膜下积脓。尽管多模态颅内监测的安全性良好，但随着侵入性床边操作数量的增加，神经外科医生必须对感染性并发症的发生保持高度警惕。
