Sugii Narushi, Matsuda Masahide, Sekine Tomokazu, Matsumura Hideaki, Yamamoto Tetsuya, Matsumura Akira
Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Neurol Surg Rep. 2017 Jul;78(3):e109-e112. doi: 10.1055/s-0037-1606315. Epub 2017 Aug 28.
We report a unique case of delayed brain swelling following craniectomy that improved rapidly after cranioplasty, and discuss the potential mechanism underlying this delayed and reversible brain swelling. A 22-year-old woman developed surgical site infection after removal of a convexity meningioma. Magnetic resonance imaging revealed an epidural abscess around the surgical site. Subsequently, the abscess was evacuated, and the bone flap was removed. Later, brain edema around the skull defect emerged and progressed gradually, despite resolution of the infection. The edematous brain developed focal swelling outward through the bone defect without ventricle dilatation. Because we suspected that the edema and swelling were caused by the state of the bone defect, we performed a cranioplasty 10 weeks after the bone flap removal, and brain edema improved rapidly. We hypothesized that the brain edema was initially caused by surgical stress and inflammation, followed by compression of cortical veins between the dural edge and brain tissue, leading to disruption of venous return and exacerbation of brain edema. When delayed focal brain edema and external swelling progress gradually after bone flap removal, after excluding other pathological conditions, cranioplasty should be considered to improve cortical venous congestion caused by postsurgical adhesion.
我们报告了一例颅骨切除术后延迟性脑肿胀的独特病例，该病例在颅骨成形术后迅速改善，并讨论了这种延迟性和可逆性脑肿胀的潜在机制。一名22岁女性在切除凸面脑膜瘤后发生手术部位感染。磁共振成像显示手术部位周围有硬膜外脓肿。随后，脓肿被引流，骨瓣被移除。后来，尽管感染已消退，但颅骨缺损周围出现了脑水肿并逐渐进展。水肿的脑组织通过骨缺损向外形成局灶性肿胀，脑室无扩张。由于我们怀疑水肿和肿胀是由骨缺损状态引起的，因此在骨瓣移除10周后进行了颅骨成形术，脑水肿迅速改善。我们推测，脑水肿最初是由手术应激和炎症引起的，随后硬脑膜边缘与脑组织之间的皮质静脉受压，导致静脉回流中断，脑水肿加重。当骨瓣移除后延迟性局灶性脑水肿和外部肿胀逐渐进展时，在排除其他病理情况后应考虑进行颅骨成形术，以改善术后粘连引起的皮质静脉淤血。
