Hedayat Hirad, Felbaum Daniel R, Reynolds John E, Janjua Rashid M
Neurosurgery, Global Neurosciences Institute.
Neurosurgery, Medstar Georgetown University Hospital.
Cureus. 2017 Dec 7;9(12):e1921. doi: 10.7759/cureus.1921.
Neurosurgical pathologies presenting during pregnancy are uncommon. If present, the situation creates a unique diagnostic, observational, and therapeutic challenge as both lives are placed at potential risk. Surgical procedures during pregnancy are approached carefully as physiological stressors associated with surgery and anesthesia may cause fetal or maternal compromise. We present the only known case of a pseudoaneurysm treated with an awake craniotomy, allowing us to abate the risks associated with general anesthesia in pregnancy. A female suffered a superficially penetrating gunshot wound to the head for which she underwent a craniotomy with complete neurological recovery. She had complaints of intermittent headaches, dizziness, and tingling of her hands five months thereafter. The cerebral angiogram demonstrated an 8 mm pseudoaneurysm under her craniotomy site. A surgical repair of this aneurysm was undertaken in the 23rd week of pregnancy via an awake craniotomy with regional scalp block. The aneurysm was resected without complication, and the patient tolerated the procedure without neurological deficit during or subsequent to the operation. Cerebrovascular pathology in pregnant patients remains a difficult situation that poses challenges associated with the pathology itself as well as the anesthetic implications inherent with operative management. The neurosurgical literature demonstrates that surgical management of cerebrovascular pathology is well-tolerated in pregnancy, and our case further demonstrates the capability of utilizing an awake craniotomy for the treatment of this type of lesion without causing a residual deficit.
孕期出现的神经外科疾病并不常见。如果出现这种情况，由于两条生命都面临潜在风险，会带来独特的诊断、观察和治疗挑战。孕期进行手术需谨慎，因为与手术和麻醉相关的生理应激因素可能导致胎儿或母体出现问题。我们报告了唯一一例已知的采用清醒开颅手术治疗假性动脉瘤的病例，这使我们能够降低孕期全身麻醉相关的风险。一名女性头部遭受表浅贯通性枪伤，为此接受了开颅手术，神经功能完全恢复。五个月后，她出现间歇性头痛、头晕和手部刺痛的症状。脑血管造影显示在她的开颅部位下方有一个8毫米的假性动脉瘤。在怀孕第23周时，通过区域头皮阻滞的清醒开颅手术对该动脉瘤进行了手术修复。动脉瘤被切除，无并发症发生，患者在手术期间及术后均未出现神经功能缺损，耐受了该手术。怀孕患者的脑血管病变仍然是一个棘手的情况，不仅存在病变本身带来的挑战，还存在手术管理中固有的麻醉相关问题。神经外科文献表明，孕期对脑血管病变进行手术管理耐受性良好，我们的病例进一步证明了利用清醒开颅手术治疗此类病变而不导致残留神经功能缺损的能力。
