Department of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Department of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
World Neurosurg. 2020 Jul;139:196-199. doi: 10.1016/j.wneu.2020.04.029. Epub 2020 Apr 18.
Incidence of chronic subdural hematoma (CSH) associated with metastases of extraneural malignancies is rare. We report a rare case of CSH wherein most of the CSH cavity was occupied with metastatic cancer cells; in addition, we review the literature.
A 68-year-old man with a history of gastric cancer presented to our hospital with dysarthria and shoulder paralysis; CSH was diagnosed from preoperative imaging findings. When the hematoma was removed via a small craniotomy, besides the hematoma, we observed an abnormal mass of tissue in the capsule. Pathologically, the mass was consistent with the findings of metastatic gastric cancer. Although the symptoms immediately disappeared postoperatively, a symptomatic acute subdural hematoma with midline shift was observed on postoperative day 27. Emergency craniotomy and hematoma and tumor removal were performed. Pathologic examination showed hemorrhagic necrosis in the tumor, which had not been initially observed. The postoperative course progressed without hematoma recurrence.
To the best of our knowledge, this is the first report of a CSH accompanied by tumor metastasis in most of the CSH cavity. Although rare, if a patient with cancer has CSH, the CSH should be treated considering the possibility of metastasis.
与颅外恶性肿瘤转移相关的慢性硬脑膜下血肿（CSH）发病率较低。我们报告了一例罕见的 CSH 病例，其中大部分 CSH 腔被转移性癌细胞占据；此外，我们还回顾了相关文献。
一名 68 岁男性，有胃癌病史，因构音障碍和肩部瘫痪就诊于我院；术前影像学检查诊断为 CSH。当通过小骨窗开颅术清除血肿时，除了血肿外，我们还在囊内观察到异常组织肿块。病理检查结果与转移性胃癌的发现一致。尽管术后症状立即消失，但在术后第 27 天观察到有中线移位的症状性急性硬脑膜下血肿。紧急行开颅血肿和肿瘤切除术。病理检查显示肿瘤有出血性坏死，这在最初并未观察到。术后病情进展无血肿复发。
据我们所知，这是首例 CSH 大部分腔被肿瘤转移占据的病例报告。虽然罕见，但如果癌症患者出现 CSH，应考虑转移的可能性来治疗 CSH。
