Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
World Neurosurg. 2023 Mar;171:8-9. doi: 10.1016/j.wneu.2022.12.007. Epub 2022 Dec 8.
A 65-year-old woman with a known right-sided, dural-based lesion and metastatic pancreatic neuroendocrine tumor presented with multiple days of progressive lethargy and left-sided weakness culminating with obtundation and dilated pupils. Computed tomography demonstrated an acute right convexity subdural hematoma and a frontotemporal intraparenchymal hemorrhage with 1.3 cm of midline shift, uncal herniation, and an increase in size of now a hemorrhagic dural-based lesion. She underwent emergency hemicraniectomy for evacuation of subdural hematoma and resection of hemorrhagic meningioma with excellent postoperative result including improvement in midline shift and gross total resection of lesion. Pathology was consistent with a World Health Organization grade II meningioma with a chordoid component. She underwent adjuvant stereotactic radiosurgery and cranioplasty and made a full neurologic recovery. Identification of hemorrhagic meningioma as the underlying pathology causing multicompartmental hemorrhage is crucial. We recommend single-stage decompression with extraaxial clot evacuation and resection of the meningioma when feasible.
一位 65 岁女性，右侧硬脑膜起源病变，伴转移性胰腺神经内分泌肿瘤，表现为进行性意识障碍伴左侧无力数日，最终出现昏迷和瞳孔扩大。计算机断层扫描显示急性右侧大脑凸面硬膜下血肿和额颞叶脑实质内出血，中线移位 1.3 厘米，小脑幕切迹疝，硬脑膜起源病变增大伴出血。患者行急症半颅脑切开术以清除硬膜下血肿和切除出血性脑膜瘤，术后效果极佳，包括中线移位改善和病变大体全切除。病理符合世界卫生组织 II 级脑膜瘤伴脊索样成分。患者接受辅助立体定向放射外科治疗和颅骨修补术，神经功能完全恢复。明确诊断为引起多腔隙出血的出血性脑膜瘤是关键。我们建议在可行的情况下行单阶段减压，清除硬脑膜外血肿并切除脑膜瘤。
