窦镰旁巨大脑膜瘤术中术后术区及远隔部位硬膜外血肿形成原因及处理

Cause and treatment of the epidural hematoma in the adjacent area and the distant location of the giant meningioma

目的:探讨窦镰旁巨大脑膜瘤切除术中临近术区及远隔部位硬膜外血肿形成的原因及处理方法。方法:回顾分析重庆医科大学附属第一医院神经外科2012年5月至2017年6月间行巨大脑膜瘤切除术前后或术后术区脑组织膨胀和远隔部位硬脑膜外血肿形成的5例患者的临床资料及原因。结果:本组患者术中出现术区脑组织膨出,脑压高或瘤体切除后脑压仍高表现,急行术中头颅B超提示术区或邻近部位出血或急诊头颅CT或术后立即复查CT提示硬膜外血肿形成。手术确认为硬膜外血肿形成。其中1例患者为明确术中远隔部位出血,另4例患者为术中明确为术区临近部位硬膜外血肿形成,术后明确为术区附近出血或伴远隔部位硬膜外出血。结论:窦镰旁巨大脑膜瘤切除术中、术后临近术区及远隔部位硬膜外出血发生率低,但十分危险。如能及时发现并处理,则预后良好。术中B超或术后复查CT有助于及时发现出血原因及部位,以免造成不必要的损伤。

Objective：To discuss on the causes and treatment of epidural hematoma in the adjacent area and distant location during the resection of giant meningioma by the sickle of the sickle. Methods：The clinical data of 5 patients with postoperative epidural hematoma who underwent giant meningioma resection in the department of neurosurgery of First Affiliated Hospital of Chongqing Medical University from May 2012 to June 2017 were retrospectively analyzed. Results：Bulging and high pressure appeared during the brain surgery. High pressure was still existed after the surgery. Intraoperative cranial ultrasound indicated bleeding in the surgery area or adjacent area. Emergency cranial CT showed the immediate postoperative epidural hematoma formation. The epidural hematoma was confirmed by the surgery（one case of bleeding in the distant location,and the other 4 cases of bleeding in the vicinity of the operation area or accompanied by a distant hemorrhage）. Conclusion：In the resection of the giant meningioma beside the sickle of the sinus,the incidence of epidural hemorrhage in the adjacent area and the distant location is low,but it is very dangerous. If it can be found and treated in time,the prognosis is good. If there are intraoperative brain swelling,high brain pressure or high brain pressure after tumor resection,intraoperative ultrasonography or immediate review of CT should be performed in time to assist the diagnosis so as not to delay the condition and cause unnecessary damage.