幕上脑肿瘤术后远隔性小脑出血临床分析

Clinical analysis on cerebellar hemorrhage after supratentorial brain tumor resection

目的探讨颅内幕上脑肿瘤切除术后远隔性小脑出血的临床表现、治疗、预后及发生机制。方法回顾性分析3例幕上脑肿瘤切除术后远隔性小脑出血患者的临床资料。并结合文献复习,分析其临床表现、治疗方案、预后。结果3例患者均表现为头痛、呕吐,其中2例患者表现进行性意识障碍。CT检查发现远隔性小脑出血发生于双侧2例,单侧1例。1例患者行后颅窝去骨瓣减压术,1例患者行小脑血肿清除术+幕上/后颅窝去骨瓣减压术,1例患者采用对症治疗后出血完全吸收。1例患者术后10 d死亡;另外2例患者出院后随访3~6个月,格拉斯哥预后量表(GOS)评分5分者1例,3分1例。结论头痛、呕吐及进行性意识障碍是幕上脑肿瘤切除术后远隔性小脑出血常见临床表现,术后早期CT检查有助于早期诊断;积极的早期治疗可明显降低患者病死、病残率,改善预后。术中及术后脑脊液流失导致颅内压急剧改变可能是其发生的机制。

Objective To investigate the remote cerebellar hemorrhage(RCH)after surgery for supratentorial clinical manifestations,treatment,prognosis and mechanism of hemorrhage.Methods The clinical data of 3 patients with RCH after supratentorial craniotomy were analyzed retrospectively.Results 3 patients presented with headache and vomiting after surgery,2 of them presented with progressive consciousness decreasing.Postoperative CT examination revealed that RCH occurred bilaterally in 2 cases and unilateral in 1.Of 3 cases,1 received posterior fossa decompression,1 received hematoma removal and supratentorial/posterior fossa decompression,and 1 recovered after symptomatic treatment.The follow-up period ranged from 0 to 6 months.The Glasgow Prognosis Score(GOS)was grade Ⅴ in 1 case,grade Ⅲ in 1 and grade Ⅰ in 1.Conclusions RCH after supratentorial craniotomy is rare.Early post-operative CT examination is helpful for early diagnosis,close monitoring,active hematoma clearance and posterior fossa decompression can significantly reduce the mortality,disability rate and improve the prognosis of patients.Intracranial pressure drops sharply during and after operation due to a large amount of cerebrospinal fluid loss which may be the mechanism.