Spanehl Lennard, Walter Uwe, Thiele Thomas, Dubinski Daniel, Behmanesh Bedjan, Freiman Thomas M, Wittstock Matthias, Schuss Patrick, Vatter Hartmut, Schneider Matthias, Gessler Florian, Won Sae-Yeon
Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Clin Med. 2024 Aug 14;13(16):4778. doi: 10.3390/jcm13164778.
The COVID-19 (coronavirus disease) pandemic had a severe impact on public health worldwide. A rare but serious complication after administration of adenoviral vaccines against SARS-CoV-2 (AstraZeneca-Oxford and Johnson & Johnson) is vaccine-induced immune thrombotic thrombocytopenia and thrombosis (VITT), which can lead to serious complications such as cerebral venous sinus thrombosis (CVST). CVST itself can cause subarachnoid hemorrhage (SAH) and/or intracerebral hemorrhage (ICH), leading to high mortality due to herniation of brain parenchyma. In those patients, an emergent decompressive hemicraniectomy (DC) is regularly performed. Herein, the authors want to focus on the patients who survive DC following VITT-associated CVST and shed light on the neurosurgical considerations in those patients. We herein propose a treatment algorithm regarding the timing and the perioperative management of cranioplasty. We describe an exemplary case highlighting that special circumstances may result in a more urgent need for autologous cranioplasty than usual, based on individual risk assessment.
新型冠状病毒肺炎（COVID-19）大流行对全球公共卫生造成了严重影响。接种针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的腺病毒疫苗（阿斯利康-牛津疫苗和强生疫苗）后出现的一种罕见但严重的并发症是疫苗诱导的免疫性血栓性血小板减少症和血栓形成（VITT），其可导致严重并发症，如脑静脉窦血栓形成（CVST）。CVST本身可引起蛛网膜下腔出血（SAH）和/或脑出血（ICH），因脑实质疝形成导致高死亡率。在这些患者中，通常会进行紧急减压性颅骨切除术（DC）。在此，作者希望关注VITT相关CVST后DC存活的患者，并阐明这些患者的神经外科考虑因素。我们在此提出一种关于颅骨修补术时机和围手术期管理的治疗算法。我们描述了一个典型案例，强调基于个体风险评估，特殊情况可能导致比通常更迫切需要自体颅骨修补术。
