Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan.
Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan.
World Neurosurg. 2019 Jul;127:160-164. doi: 10.1016/j.wneu.2019.04.022. Epub 2019 Apr 9.
Symptomatic cyst formation after brain tumor resection is a rare complication of the early postoperative phase. We describe a complicated case of postoperative symptomatic cyst formation after gross total removal of a convexity meningioma.
A 59-year-old woman presented with recent onset motor aphasia. Magnetic resonance imaging revealed a left convexity tumor. We performed gross total resection of the tumor, which was pathologically diagnosed as an atypical meningioma. Tumor resection and decompression of the normal cerebral hemisphere improved aphasia. However, 3 days after surgery, her motor aphasia worsened. Computed tomography scan confirmed that the frontal lobe was being compressed by an enlargement of the postoperative tumor cavity. Conservative therapy did not shrink the cavity, and her motor aphasia persisted. Therefore, 21 days after surgery, a drainage tube was inserted into the enlarged cavity using a neuroendoscope, which promoted shrinkage of the cavity and improved her motor aphasia. We suspected that the enlargement of the postoperative cavity was because of the presence of a valve-like structure.
Even though formation of symptomatic cystic lesions after brain tumor resection is rare, neurosurgeons should be aware of such early postoperative complications and their management strategies.
脑肿瘤切除术后出现症状性囊肿是早期术后阶段的罕见并发症。我们描述了一例脑膜瘤全切除术后并发症状性囊肿形成的复杂病例。
一名 59 岁女性因近期出现运动性失语症就诊。磁共振成像显示左额凸面肿瘤。我们行肿瘤全切除,术后病理诊断为非典型脑膜瘤。肿瘤切除和正常大脑半球减压改善了失语症。然而,术后 3 天,她的运动性失语症恶化。计算机断层扫描证实额叶被术后肿瘤腔扩大所压迫。保守治疗未能使腔缩小,且她的运动性失语症持续存在。因此,术后 21 天,使用神经内镜将引流管插入扩大的腔中,促进了腔的缩小并改善了她的运动性失语症。我们怀疑术后腔扩大是因为存在瓣膜样结构。
尽管脑肿瘤切除术后形成症状性囊性病变较为罕见,但神经外科医生应了解此类早期术后并发症及其处理策略。