Fernandes Rafael Tiza, Sobrinho Rui, Azevedo Miguel, Matos Mário, Sagarribay Amets, Forte Dalila
Department of Neurosurgery, Hospital de São José, ULS São José, Lisbon, Portugal.
Department of Neurosurgery, Hospital Garcia de Orta, ULS Almada-Seixal, Almada, Portugal.
Childs Nerv Syst. 2025 Jan 4;41(1):81. doi: 10.1007/s00381-024-06726-9.
Subdural hematoma (SDH) typically occurs due to traumatic brain injury but can arise as a rare complication of procedures like endoscopic third ventriculostomy (ETV).
We report an unusual case in a 9-year-old male with previous resection of a fourth-ventricle ependymoma at 2 years of age. Seven years post-surgery, he presented with worsening hydrocephalus and underwent ETV. One month later, he developed severe headaches and motor difficulties. Imaging revealed a significant right SDH, necessitating urgent drainage. Postoperative recovery was uneventful, and follow-up imaging showed resolution of the hematoma.
ETV is generally preferred for obstructive hydrocephalus due to lower complication rates compared to shunt procedures. However, cases of SDH post-ETV remain reported, albeit rarely. Potential mechanisms include altered cerebrospinal fluid dynamics and intraoperative vessel injury. This case aligns with literature findings and reinforces the importance of postoperative monitoring and prompt intervention in symptomatic cases to prevent complications.
Clinicians should consider SDH in pediatric patients with new symptoms post-ETV. Further research should focus on understanding the risk factors and mechanisms for SDH development.
硬膜下血肿（SDH）通常由创伤性脑损伤引起，但也可能作为内镜下第三脑室造瘘术（ETV）等手术的罕见并发症出现。
我们报告一例罕见病例，患者为一名9岁男性，曾在2岁时接受第四脑室室管膜瘤切除术。术后7年，他出现脑积水加重并接受了ETV手术。一个月后，他出现严重头痛和运动障碍。影像学检查显示右侧有大量硬膜下血肿，需要紧急引流。术后恢复顺利，随访影像学检查显示血肿消退。
由于与分流手术相比并发症发生率较低，ETV通常是梗阻性脑积水的首选治疗方法。然而，ETV术后发生硬膜下血肿的病例仍有报道，尽管很少见。潜在机制包括脑脊液动力学改变和术中血管损伤。该病例与文献报道结果一致，强化了术后监测以及对有症状病例进行及时干预以预防并发症的重要性。
临床医生应考虑到ETV术后出现新症状的儿科患者发生硬膜下血肿的可能性。进一步的研究应集中于了解硬膜下血肿发生的危险因素和机制。
