Benifla Mony, Laughlin Suzzanne, Tovar-Spinoza Zulma S, Rutka James T, Dirks Peter B
Divisions of Neurosurgery, Neuroradiology, and Neurooncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Pediatr Neurosurg. 2017;52(3):205-210. doi: 10.1159/000452803. Epub 2017 Mar 22.
Postsurgical deep brain venous thrombosis has not been well described in children before. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the internal cerebral veins (ICVs) and the vein of Galen. However, even when they are well preserved during surgery, postoperative hemodynamic changes, mainly in the first 24 h, or surgical manipulation can cause thrombosis of these veins. We report 2 children with unilateral postoperative ICV thrombosis; in 1 of the patients the vein of Galen was also thrombosed. Although both patients had altered sensorium initially, no anticoagulation therapy was given, and they both recovered well. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the ICV and the vein of Galen. The surgeon should respect the deep brain venous system when approaching midline structures. Both the neurosurgeon and the neuroradiologist should be aware of this possible complication in order to make a prompt diagnosis and to offer proper treatment if needed.
此前儿童术后脑深部静脉血栓形成的情况尚未得到充分描述。在处理丘脑或脑室内病变时,应格外小心以防止损伤大脑内静脉(ICV)和大脑大静脉。然而,即使在手术过程中它们得到了妥善保护,术后的血流动力学变化(主要在最初24小时内)或手术操作仍可能导致这些静脉发生血栓形成。我们报告了2例单侧术后ICV血栓形成的儿童病例;其中1例患者的大脑大静脉也发生了血栓形成。尽管两名患者最初均有意识改变,但均未给予抗凝治疗,且两人均恢复良好。在处理丘脑或脑室内病变时,应格外小心以防止损伤ICV和大脑大静脉。外科医生在接近中线结构时应尊重脑深部静脉系统。神经外科医生和神经放射科医生都应意识到这种可能的并发症,以便及时做出诊断并在需要时提供适当的治疗。