横窦沟微型硬膜外血肿

Mini Epidural Hematoma in the Transverse Sinus Groove

因枕骨线形骨折穿过横窦沟所引起的微型硬膜外血肿,平均体积3ml大小,因影响颅内静脉窦回流,而致颅内压增高,这一少见的特殊类型的血肿,由于缺乏明显的定位征象,常被遗误。作者报告27例经手术或CT证实的病例,提出诊断要点:多见于儿童和青年;枕部遭受减速性损伤;脑原发损伤常属轻～中型;伤后渐次出现进行性颅内压增高,约一周左右达高峰;无神经系统定位征象;X线平片可见枕骨线形骨折穿越横窦沟,右侧多于左侧;姑息治疗效果不佳;缓脉及眼底水肿较明显;CT扫描检查可显示高密度小血肿影;手术清除微型血肿可获极佳效果。作者同时还讨论了发病机制和手术方法。

Mini epidural hematoma,about 3ml in average in size,caused by linear fracture of occipital bone across the groove of transverse sinus may affect the venous drainage and lead to intracranial hypertension.This relatively rare clinical situation without localized neurological symptoms and signs is often over-looked and treated inappro- priately.From an analysis of the total 27 cases,a definite clinical feature can be described,A typic history including a decelerating injury of occipital,linear fracture across the groove of transverse sinus,more frequently seen on the right side,a subacute process with mild to moderate brain damage,progressive intracranial hypertension without localized symptoms and signs,and unsatisfactory results with conservative treatment.Echoencephalography and angiography are negative in most of the cases,The CT scan is available for investigation of this mini epidural hematoma. The pathogenesis is closely related to anatomy and function of the transverse sinus. It was well known that the attachment between the posterior wall of transverse sinus and the transverse sinus groove of occipitad bone is loose and easy to be sepa rated while the attachment of surrounding dural mater are tightly adhered to occiput and the edges of transverse groove.Therefore,the blood leakage from deploe vein following fracture is accumulated within the groove to form a mini epidural hematoma which compresses the transverse sinus and block the venous drainage of cerebrum leading to intracranial hypertension.A attenuated posterior wall of transverse sinus with a relatively low tension is also responsible. Surgical treatment of this mini epidural hematoma is simple and very effective. Detailed principles of diagnosis and surgical operation are introduced.