Department of Neurosurgery, Affiliated Hospital of Qinghai University, Xining, China.
Br J Neurosurg. 2024 Apr;38(2):536-539. doi: 10.1080/02688697.2020.1859093. Epub 2020 Dec 11.
Cranioplasty is a relatively simple neurosurgical procedure, and common complications of cranioplasty include dural tears, CSF leakage, infection, epilepsy, epidural hematoma and bone flap resorption. Intracerebral hemorrhage as a complication of cranioplasty is rare, and it is often fatal. The report describes one case of delayed severe intracerebral and intraventricular hemorrhage after an uneventful cranioplasty.
A previously healthy 29-year-old man was admitted to our hospital with a traumatic left frontotemporoparietal acute subdural hematoma, an emergency decompressive craniectomy with clot removal was performed. Four months after the surgery, cranioplasty was performed with a titanium mesh, the surgery was uneventful. Six hours after the operation, a CT scan demonstrated no bleeding or edema. In the following 2 days after cranioplasty, the patient did not have any neurological deficits, normal blood pressure was recorded every day, no trauma occurred, and routine laboratory test results were within normal limits. However, on the third day after cranioplasty, the patient suffered a sudden severe headache while playing games on his mobile phone, and then rapidly fell into deep coma; both pupils were fixed and dilated at 5 mm with no response to light. An immediate CT scan revealed a massive intracerebral hematoma and intraventricular hematoma on the left side, and the midline shifted to the right side. Therefore, an ipsilateral decompressive craniectomy was performed with evacuation of the hematoma; the obvious bleeding point was not identified, and no obvious vascular abnormalities were found during the operation. A CT scan on day 3 after reoperation revealed successful decompression, and CT angiography showed no vascular abnormalities. Despite all treatment measures, the patient did not regain consciousness, his neurological situation did not improve after the operation, and the patient lived in a vegetative state.
Although intracerebral and intraventricular hemorrhage after cranioplasty is extremely rare, it is often fatal. Aside from hyperperfusion and cerebral autoregulation dysfunction, traction injuries to the fragile vessels due to posttraumatic angiogenesis may also be one of the key factors of complications after cranioplasty.
颅骨修补术是一种相对简单的神经外科手术，颅骨修补术的常见并发症包括硬脑膜撕裂、CSF 漏、感染、癫痫、硬膜外血肿和骨瓣吸收。颅骨修补术后颅内出血作为一种并发症较为罕见，但往往是致命的。本文报告了一例颅骨修补术后迟发性严重颅内和脑室内出血的病例。
一位既往健康的 29 岁男性，因外伤性左额颞顶枕急性硬膜下血肿就诊，急诊行去骨瓣减压血肿清除术。术后 4 个月，行颅骨修补术，使用钛网，手术过程顺利。术后 6 小时行 CT 扫描未见出血或水肿。颅骨修补术后 2 天，患者无任何神经功能缺损，每天记录血压正常，无外伤，常规实验室检查结果正常。然而，颅骨修补术后第 3 天，患者在玩手机游戏时突然出现剧烈头痛，随后迅速陷入深昏迷；双侧瞳孔固定扩大至 5mm，对光无反应。立即行 CT 扫描显示左侧大量颅内血肿和脑室内血肿，中线向右移位。因此，行同侧减压性颅骨切除术，清除血肿；术中未发现明显出血点，也未发现明显血管异常。术后第 3 天的 CT 扫描显示减压成功，CT 血管造影显示无血管异常。尽管采取了所有治疗措施，患者仍未恢复意识，术后神经状况无改善，患者处于植物人状态。
尽管颅骨修补术后颅内和脑室内出血极为罕见，但往往是致命的。除了过度灌注和脑自动调节功能障碍外，创伤后血管生成导致的脆弱血管的牵引损伤也可能是颅骨修补术后并发症的关键因素之一。
