Bombay Hospital and Institute of Medical Sciences, Mumbai, India.
Acta Neurochir Suppl. 2023;130:41-45. doi: 10.1007/978-3-030-12887-6_6.
A 52-year-old man was admitted to our hospital with symptoms of raised intracranial pressure and cerebellar dysfunction caused by a medium-sized (4 cm in diameter) tentorial meningioma with an infratentorial extension. Preoperative magnetic resonance imaging showed that the tumor indented and possibly partially invaded the adjacent junction of the nondominant transverse and sigmoid sinuses. The contralateral dominant transverse sinus was fully patent. Total surgical removal of the lesion was done through the left retrosigmoid approach. During dissection of the meningioma, some bleeding from the venous sinus was noted, which was easily controlled by packing with hemostatic materials. The initial postoperative period was unremarkable, but approximately 48 h after surgery, acute clinical deterioration caused by hemorrhagic venous infarction of the left cerebellar hemisphere and brain stem developed and necessitated urgent reoperation for the evacuation of hematoma and brain decompression. Thereafter, the patient remained in a prolonged coma with a severe neurological deficit. After several years of extensive neurorehabilitation, he was able to walk with support but had a tracheostomy, required a feeding tube, and voided with a urinary catheter. Such a catastrophic outcome after an apparently trivial nondominant transverse sinus injury during resection of a tentorial meningioma raises the question whether reconstruction of the sinus wall with preservation of its patency might have prevented this complication in our patient.
一位 52 岁男性因颅内压升高和小脑功能障碍入院，其病因是直径约 4cm 的天幕脑膜瘤，并向幕下延伸。术前磁共振成像显示肿瘤凹陷，可能部分侵犯相邻的非优势横窦和乙状窦交界处。对侧优势横窦完全通畅。通过左乙状窦后入路进行了病变的全切除。在脑膜瘤的解剖过程中，发现一些静脉窦出血，用止血材料填塞很容易控制。术后初期无明显异常，但术后约 48 小时，因左侧小脑半球和脑干出血性静脉梗死导致急性临床恶化，需要紧急再次手术清除血肿和减压。此后，患者持续处于深度昏迷状态，伴有严重的神经功能缺损。经过数年广泛的神经康复，他能够在辅助下行走，但仍需要进行气管切开、胃管喂食和导尿。在切除天幕脑膜瘤时，看似轻微的非优势横窦损伤后出现如此灾难性的结果，这不禁让人怀疑在我们的患者中，保留静脉窦通畅性的窦壁重建是否可以预防这种并发症。
