Shen Liang, Zhou Yue, Xu Jie, Su Zhongzhou
Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China.
Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China.
World Neurosurg. 2018 Feb;110:4-10. doi: 10.1016/j.wneu.2017.10.102. Epub 2017 Oct 28.
Cranioplasty is considered a low-risk operation in the field of neurosurgery following decompression craniectomy. Well-known complications after cranioplasty, such as infection, seizure, and titanium plate exposure, may not threaten the lives of patients. Unfortunately, there are many fatal complications that are underreported. In this study, we report a case and perform a literature review to introduce malignant cerebral swelling, which is regarded as a devastating complication.
A 51-year-old man who was a victim of traumatic brain injury underwent emergency clot removal and decompression craniectomy. His neurologic condition improved with subsequent rehabilitation therapy, and he had left sinking skin flap syndrome where the skull was defective. Six months after the initial surgery, he underwent a cranioplasty; however, he did not recover from the uneventful anesthesia. A vacuum suction drain showed 300 mL of flow outflow had drained when his pupils dilated and fixed. An immediate computed tomography scan showed ipsilateral diffuse cerebral swelling with diffuse cerebral hemorrhage. Despite all approaches that were considered, the cerebral swelling continued to worsen until death.
Cranioplasty is a high-risk procedure in some cases. Sinking skin flap syndrome and vacuum suction drain may be the main risks of a postoperative venous congestion and stasis, which may result in diffuse cerebral swelling. Once the computed tomography scan shows malignant cerebral swelling, the patient is expected to have a poor prognosis.
颅骨成形术在颅骨减压切除术后的神经外科领域被认为是一种低风险手术。颅骨成形术后的常见并发症，如感染、癫痫发作和钛板外露，可能不会威胁患者生命。不幸的是，有许多致命并发症未得到充分报道。在本研究中，我们报告一例病例并进行文献综述，以介绍恶性脑肿胀，这被视为一种毁灭性并发症。
一名51岁的男性，因创伤性脑损伤接受了紧急血块清除和颅骨减压切除术。经过后续康复治疗，他的神经状况有所改善，但出现了颅骨缺损导致的左侧凹陷性皮瓣综合征。初次手术后6个月，他接受了颅骨成形术；然而，他在平稳的麻醉后未能恢复。当他的瞳孔散大固定时，一根负压吸引引流管显示流出了300毫升液体。立即进行的计算机断层扫描显示同侧弥漫性脑肿胀并伴有弥漫性脑出血。尽管采取了所有考虑到的措施，脑肿胀仍持续恶化直至患者死亡。
在某些情况下，颅骨成形术是一种高风险手术。凹陷性皮瓣综合征和负压吸引引流可能是术后静脉充血和淤滞的主要风险，这可能导致弥漫性脑肿胀。一旦计算机断层扫描显示恶性脑肿胀，患者预后可能较差。
