Destiansyah Rifqi Aulia, Savitri Camilia Metadea Aji, Wisnawa I Wayan Weda, Susilo Rahadian Indarto, Wahyuhadi Joni, Haq Irwan Barlian Immadoel
Department of Neurosurgery, Soetomo Academic General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Department of Environmental and Preventive Medicine, Faculty of Medicine, Ōita University, Ōita, Japan.
Int J Surg Case Rep. 2022 Jul;96:107341. doi: 10.1016/j.ijscr.2022.107341. Epub 2022 Jun 23.
The sellar region is one of the most areas to access in skull base surgery. The endoscopic transsphenoidal approach is a minimally invasive technique developed to create a clear trajectory to the sellar region through the sellar floor. Conversely, this area is surrounded by major intracranial vessels and multiple cranial nerves, hence, every surgical procedure to access this area carries dangerous complications, including hematoma. Remote extradural hematoma is an extremely rare complication following the endoscopic transsphenoidal approach, and the pathogenesis has not been elucidated.
This study reported a case of 38-years old female suffered from chronic cephalgia and bilateral vision loss since one year ago. Further neuroimaging examination showed solid extra-axial mass, suggesting pituitary adenoma. Laboratory result showed increased Prolactin (216,2 ng/dl) with no other hormonal disturbance. Urgent endoscopic transsphenoidal surgery was planned to excise the tumor. Post-operative CT showed acute right frontal extradural hematoma, in which the patient was planned to have immediate surgery afterwards.
The specific mechanism of developing EDH post-surgery is unknown because it is an unusual consequence of endoscopic transsphenoidal surgery. Rapid CSF draining during surgery may have led to the formation of a remote extradural hematoma in our patient.
Endoscopic transsphenoidal surgery also carries the potential risk of remote extradural hematoma, careful steps must be taken to prevent this serious complication during transsphenoidal surgery.
鞍区是颅底手术中最易触及的区域之一。内镜经蝶窦入路是一种微创技术，旨在通过蝶窦底部创建一条通向鞍区的清晰路径。相反，该区域被主要的颅内血管和多条颅神经所环绕，因此，每一种进入该区域的手术都存在危险的并发症，包括血肿。远处硬膜外血肿是内镜经蝶窦入路术后极为罕见的并发症，其发病机制尚未阐明。
本研究报告了一例38岁女性患者，自一年前起患有慢性头痛和双侧视力丧失。进一步的神经影像学检查显示轴外实性肿块，提示垂体腺瘤。实验室检查结果显示催乳素升高（216.2 ng/dl），无其他激素紊乱。计划紧急进行内镜经蝶窦手术切除肿瘤。术后CT显示急性右侧额部硬膜外血肿，随后计划对患者立即进行手术。
术后发生硬膜外血肿的具体机制尚不清楚，因为这是内镜经蝶窦手术的一种不寻常后果。手术期间快速引流脑脊液可能导致了我们患者远处硬膜外血肿的形成。
内镜经蝶窦手术也存在远处硬膜外血肿的潜在风险，在经蝶窦手术期间必须采取谨慎措施以预防这种严重并发症。
