Maki Yoshinori, Ishibashi Ryota, Yamada Daisuke, Morita Takumi, Chin Masaki, Yamagata Sen
Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
World Neurosurg. 2017 Jul;103:951.e1-951.e3. doi: 10.1016/j.wneu.2017.03.102. Epub 2017 Mar 30.
Bone wax is a hemostatic agent well used by neurosurgeons to prevent bleeding from bone. However, several complications involving bone wax have been reported, such as ptosis, infection, paraplegia, osteohypertrophy, edema, pain, granuloma formation, allergic reaction, and thrombosis.
A 47-year-old female patient presented to our neurosurgery department complaining of headache and vomiting. Subarachnoid hemorrhage from a ruptured aneurysm was detected on computed tomography (CT), and we performed emergent clipping of the ruptured aneurysm. During the maneuvers of craniotomy, the frontal base was slightly opened and bone wax of 6.7 × 3.5 × 5.7 mm was used to prevent bleeding from the bone edge and also to cover the opened site of the frontal base. Postoperatively, the patient started to complain of right ptosis and vertical diplopia. A CT image revealed that the bone wax in the right orbit was compressing the superior rectus muscle and the levator palpable muscle, which was thought to be the cause of the clinical symptoms. Removal of the bone wax was performed on postoperative day 21, after the patient surpassed the spasm period after subarachnoid hemorrhage without aggravation of neurologic deficits. Postoperative CT image confirmed removal of the bone wax in the orbit. The right ptosis and diplopia improved partially after the second operation.
The authors report a case with complications of ptosis and diplopia after the use of bone wax. Bone wax should be used minimally to the extent possible to avoid an unexpected harmful event.
骨蜡是神经外科医生常用的一种止血剂，用于防止骨出血。然而，已有数例涉及骨蜡的并发症报道，如眼睑下垂、感染、截瘫、骨质增生、水肿、疼痛、肉芽肿形成、过敏反应和血栓形成。
一名47岁女性患者因头痛和呕吐就诊于我院神经外科。计算机断层扫描（CT）检查发现动脉瘤破裂导致蛛网膜下腔出血，我们对破裂的动脉瘤进行了紧急夹闭术。在开颅手术过程中，额底稍有打开，使用了一块6.7×3.5×5.7毫米的骨蜡来防止骨边缘出血，并覆盖额底的开放部位。术后，患者开始抱怨右眼上睑下垂和垂直复视。CT图像显示，右侧眼眶内的骨蜡压迫上直肌和提上睑肌，这被认为是临床症状的原因。在患者度过蛛网膜下腔出血后的痉挛期且神经功能缺损未加重后，于术后第21天取出骨蜡。术后CT图像证实眼眶内的骨蜡已被取出。第二次手术后，右眼上睑下垂和复视部分改善。
作者报告了一例使用骨蜡后出现上睑下垂和复视并发症的病例。应尽可能少用骨蜡，以避免意外的有害事件发生。
