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颅骨凹陷性骨折继发上矢状窦狭窄所致颅内高压:病例报告及文献复习

Intracranial hypertension caused by superior sagittal sinus stenosis secondary to a depressed skull fracture: Case report and review of the literature.

作者信息

Zabalo San Juan Gorka, Vázquez Míguez Alfonso, Zazpe Cenoz Idoya, Casajús Ortega Ainhoa, García Campos Mariate, de Frutos Marcos Daniel, García Romero Juan Carlos

机构信息

Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona (Navarra), Spain.

Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona (Navarra), Spain.

出版信息

Neurocirugia (Engl Ed). 2019 Sep-Oct;30(5):243-249. doi: 10.1016/j.neucir.2018.10.002. Epub 2018 Nov 16.

Abstract

Depressed fractures that occur on the superior sagittal sinus (SSS) cause stenosis or thrombosis of the sinus in 11.5% of cases. Despite this, the appearance of signs and symptoms derived from high intracranial pressure is an infrequent event. So far, only 17 cases of venous sinus injury causing intracranial hypertension have been documented. It is necessary to establish treatment immediately before clinical suspicion. Surgical treatment by craniectomy is a fast, effective and safe alternative according to the series. However, it is necessary to anticipate the possibility of haemorrhage in the operating room. The case of a 7-year-old girl admitted for traumatic brain injury (TBI) with the diagnosis of a left parasagittal occipital sinus fracture that stenosed the posterior third of the superior sagittal sinus is presented. Upon arrival, she was asymptomatic, and conservative management was selected. Subsequently, the patient began to present with headache, nausea, vomiting and diplopia associated with bradycardia and apnoea pauses of central origin. She underwent surgery with a craniectomy with satisfactory clinical and radiological evolution and normalization of the intracranial pressure (ICP) registry.

摘要

发生于上矢状窦(SSS)的凹陷性骨折在11.5%的病例中会导致窦狭窄或血栓形成。尽管如此,由高颅内压引起的体征和症状并不常见。到目前为止,仅有17例静脉窦损伤导致颅内高压的病例被记录。在临床怀疑之前就有必要立即确定治疗方案。根据系列研究,通过颅骨切除术进行手术治疗是一种快速、有效且安全的选择。然而,有必要预估手术室中出血的可能性。本文介绍了一名7岁女孩的病例,她因创伤性脑损伤(TBI)入院,诊断为左枕窦旁矢状窦骨折,导致上矢状窦后三分之一狭窄。入院时,她没有症状,因此选择了保守治疗。随后,患者开始出现头痛、恶心、呕吐和复视,并伴有心动过缓和中枢性呼吸暂停。她接受了颅骨切除手术,临床和影像学进展良好,并使颅内压(ICP)记录恢复正常。

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