幕上手术后远隔幕下部位出血的原因分析

Analysis of the Causes of Remote Cerebellar Hemorrhage after Supratentorial Surgery

目的探讨幕上手术后远隔幕下部位出血的临床特点、发病原因、影像学表现及相关干预结果。方法分析2009年1月-2011年1月2例经幕上手术后出现远隔幕下部位出血的病例的临床资料。1例患者因颅内动脉瘤经翼点入路行动脉瘤夹闭术,术后出现远隔幕下部位出血;1例患者因硬膜下血肿行钻孔引流术,术后出现远隔幕下部位出血。结果 2例幕上手术患者均在术中或(和)术后大量引流脑脊液,术后发生出血部位均位于远隔幕下,均行积极手术干预,恢复良好,格拉斯预后评分均为4分。结论过度引流可能为引起幕上手术后形成远隔幕下部位出血的主要原因,术前、术中、术后应给予高度重视,并通过少量间断引流脑脊液可以尽量避免发生。

Objective To investigate on the clinical features,causes,image characteristics,and interventional effects of remote cerebellar hemorrhage after supratentorial surgery.Methods The clinical data of two patients with remote cerebellar hemorrhage after supratentorial surgery from January 2009 to January 2011 were retrospectively analyzed.One patient with ruptured aneurysm treated by microsurgery by the pterional approach had remote cerebellar hemorrhage after the operation;the other patient with subdural hematoma treated by trepanation and drainage had remote cerebellar hemorrhage after the operation,too.Results Excessive cerebrospinal fluid was drained for both the two patients during or after supratentorial surgery,and they both had remote cerebellar hemorrhage after the operation.Aggressive surgical intervention was carried out and the patients recovered well.According to Glasgow outcome scale,the curative effects were good in both patients with a score of 4.Conclusion Excessive drainage may cause the formation of remote cerebellar hemorrhage after supratentorial surgery,and it should be given high priority to maximize the prevention by small amount and intermittent drainage of cerebrospinal fluid during all the preoperative,intraoperative and postoperative periods.