Sattouf Mohammad, Haddad Sultaneh, Abboud Fares, Jabaly Sara, AlHayek Jamil
Division of Neurosurgery, Assad University Hospital, Damascus, Syrian Arab Republic.
Division of Pediatric, Children's Hospital, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
Int J Surg Case Rep. 2024 Sep;122:110060. doi: 10.1016/j.ijscr.2024.110060. Epub 2024 Jul 20.
An Epidural hematoma following a Ventriculoperitoneal shunt is a critically rare complication. Due to that rarity and potential dangers, we present a case where the patient became symptomatic 8 h after shunting requiring craniotomy for evacuation of the hematoma. The literature and treatment options were discussed.
A 40-year-old male arrived to the emergency department in a comatose state with dilated pupils, 8 h post-ventriculoperitoneal shunt placement. Computed tomography showed a massive hyperacute epidural hematoma causing severe midline deviation and subfalcine herniation, leading to emergency craniotomy. Despite surgical intervention and intensive care, the patient's condition did not improve, resulting in his death.
Epidural hematomas (EDHs) are an infrequent complication of ventricular drainage procedures, occurring at a documented frequency of 0.4 %, often presenting with symptoms mimicking shunt malfunction or mass lesions. Diagnosis involves computed tomography (CT) scans, but magnetic resonance imaging (MRI) may be more sensitive. Treatment options include conservative management and surgical intervention, with prognosis heavily dependent on the patient's neurological status at the time of surgery, with mortality rates varying based on level of consciousness.
This study presents a rare case of fatal hyperacute epidural hematoma following Ventriculoperitoneal shunt (VPS) placement in a 40-year-old man, highlighting the importance of early detection and intervention. The hypotheses suggests overloaded pressure on the dura during ventricular end insertion. Despite available treatment options, patient prognosis depends on neurological status at the time of surgery, emphasizing the need for further research into effective management strategies for this complication.
脑室腹腔分流术后发生硬膜外血肿是一种极为罕见的并发症。鉴于其罕见性和潜在危险性，我们报告一例患者在分流术后8小时出现症状，需要进行开颅手术以清除血肿。并对相关文献和治疗选择进行了讨论。
一名40岁男性在脑室腹腔分流术后8小时昏迷状态被送至急诊科，瞳孔散大。计算机断层扫描显示巨大的超急性硬膜外血肿，导致严重的中线移位和大脑镰下疝，遂紧急进行开颅手术。尽管进行了手术干预和重症监护，患者病情仍未改善，最终死亡。
硬膜外血肿是脑室引流手术中罕见的并发症，文献记载发生率为0.4%，常表现出类似分流功能障碍或占位性病变的症状。诊断需借助计算机断层扫描（CT），但磁共振成像（MRI）可能更敏感。治疗选择包括保守治疗和手术干预，预后很大程度上取决于手术时患者的神经状态，死亡率因意识水平而异。
本研究报告了一例40岁男性在脑室腹腔分流术（VPS）后发生致命性超急性硬膜外血肿的罕见病例，强调了早期发现和干预的重要性。推测脑室端插入时硬脑膜压力过载。尽管有多种治疗选择，但患者预后取决于手术时的神经状态，这凸显了对该并发症有效管理策略进行进一步研究的必要性。
