Zhang Xiaoyang, Pan Baogen, Ye Zhanying, Li Zheng, Mo Feng, Wang Xiaoyan
Department of Neurosurgery, Hebei Provincial General Hospital, Shijiazhuang, Hebei, China.
J Neurol Surg A Cent Eur Neurosurg. 2019 Nov;80(6):498-502. doi: 10.1055/s-0039-1688726. Epub 2019 May 10.
Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication.
The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic.
It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.
颅骨修补术是神经外科的常见手术。通常在减压性颅骨切除术（DC）后进行。然而，术后可能会出现并发症，如大面积脑肿胀。到目前为止，对这种严重并发症的关注太少。我们报告1例颅骨修补术后致命性脑肿胀病例，并分析该并发症的可能机制。
患者为40岁男性，患有严重的右侧基底节脑出血，约2个月前接受了减压性颅骨切除术。在预定的颅骨修补术前一天，进行了腰椎脑脊液引流。颅骨修补术本身顺利。然而，术后20小时他逐渐陷入昏迷，右侧瞳孔中度散大。脑部计算机断层扫描（CT）显示右侧大面积脑水肿，压迫右侧中脑。患者未恢复意识，仍四肢瘫痪。
有必要提高对高危患者颅骨修补术并发症的认识。从该病例中吸取的教训包括避免过度引流脑脊液。脑部有低密度病变的患者需要谨慎治疗。一旦CT扫描显示大面积脑肿胀，患者预后较差。
