Yomo Munetaka, Isozaki Makoto, Kikuta Ken-Ichiro
Department of Neurosurgery, Tannan Regional Medical Center.
No Shinkei Geka. 2021 Jan;49(1):193-197. doi: 10.11477/mf.1436204375.
There have been few reports about acute brain swelling caused by unruptured aneurysm surgery. We report a case of fatal acute brain swelling after clipping of an unruptured anterior communicating artery aneurysm following lung cancer surgery. A 65-year-old man underwent aneurysm neck clipping for an unruptured anterior communicating artery aneurysm by interhemispheric approach 35 days after curative resection of lung cancer. Immediately after the operation, his recovery from anesthesia was prolonged and anisocoria developed. Therefore, we performed emergent reoperation and encountered acute brain swelling necessitating decompressive craniectomy. Despite intensive medication including barbiturate therapy, the patient died 4 days after the operation. Autopsy revealed that brain swelling was caused by congestion with thrombus in the superior sagittal sinus apart from the site of the craniotomy. Fatal sinus thrombosis might develop during neurosurgical operation in patients with cancer.
关于未破裂动脉瘤手术引起急性脑肿胀的报道较少。我们报告一例肺癌手术后未破裂前交通动脉瘤夹闭术后发生致命性急性脑肿胀的病例。一名65岁男性在肺癌根治性切除术后35天，通过半球间入路对未破裂的前交通动脉瘤进行瘤颈夹闭。术后立即出现麻醉苏醒延迟和瞳孔不等大。因此，我们进行了急诊再次手术，发现急性脑肿胀，需要行减压性颅骨切除术。尽管进行了包括巴比妥类药物治疗在内的强化药物治疗，患者仍在术后4天死亡。尸检显示，除开颅部位外，上矢状窦血栓形成导致脑充血，进而引起脑肿胀。癌症患者在神经外科手术期间可能发生致命性窦血栓形成。
