Schupper Alexander J, Devarajan Alex, Lee Dong-Seok, Perez Enrique, Shrivastava Raj K
Departments of1Neurological Surgery.
2Thoracic Surgery, and.
J Neurosurg Case Lessons. 2023 May 22;5(21). doi: 10.3171/CASE233.
The complexity of posterior fossa surgery can often lead to rare complications due to the anatomy involved. Vestibular schwannoma resection is a common pathology in the posterior fossa, often requiring surgical intervention. Given the proximity of this space to the brainstem, cranial nerve VII/VIII complex, and posterior inferior cerebellar artery (PICA), neurovascular complications are not infrequent. A rare vascular complication from this surgical approach is a lateral medullary infarction from injury to the lateral medullary segment of the proximal PICA, leading to central hypoventilation syndrome (CHS).
This report presents a unique case of a 51-year-old man who underwent a retrosigmoid craniectomy for resection of a vestibular schwannoma. Following surgery, the patient was unable to be weaned off the ventilator and was noted to become apneic while he slept, a clinical picture consistent with Ondine's curse.
This report discusses the anatomical considerations of this surgical corridor leading to this complication and the management of a patient with acquired Ondine's curse and reviews the scarce literature on this uncommon cause of acquired CHS.
由于所涉及的解剖结构，后颅窝手术的复杂性常常会导致罕见的并发症。前庭神经鞘瘤切除术是后颅窝常见的病理情况，通常需要手术干预。鉴于该区域与脑干、颅神经VII/VIII复合体以及小脑后下动脉（PICA）相邻，神经血管并发症并不罕见。这种手术方式罕见的血管并发症是近端PICA外侧延髓段损伤导致的外侧延髓梗死，进而引发中枢性低通气综合征（CHS）。
本报告介绍了一例独特病例，一名51岁男性因前庭神经鞘瘤切除术接受了乙状窦后开颅手术。术后，患者无法撤机，且在睡眠时出现呼吸暂停，临床表现符合翁丁氏咒诅综合征。
本报告讨论了导致该并发症的此手术通道的解剖学因素以及获得性翁丁氏咒诅综合征患者的管理，并回顾了关于这种罕见的获得性CHS病因的稀少文献。
