颅内表皮样囊肿自发破裂并发静脉窦血栓1例及文献复习

Spontaneous rupture of intracranial epidermoid cyst complicated with venous sinus thrombosis:a case report and literature review

目的探讨颅内表皮样囊肿自发破裂并发静脉窦血栓的临床、影像学表现及诊疗经验。方法回顾性分析1例颅内表皮样囊肿自发破裂并发静脉窦血栓患者的临床资料,并对相关文献进行复习。结果患者,男,51岁,因表皮样囊肿破裂后出现头痛症状就医,入院后病情进展迅猛,考虑并发静脉窦血栓。急诊行双侧去骨瓣减压术,术中于中线钻孔并切开上矢状窦,显微吸引器吸出“蚯蚓样”长条血肿,证实为上矢状窦静脉窦血栓。术后患者仍处于深昏迷,GCS(1-T-1),呼吸机辅助机械通气,双侧瞳孔散大到边,血压需大剂量去甲肾上腺素维持。结论对于存在化学性脑炎高风险因素的颅内表皮样囊肿破裂者,在临床诊治过程中有必要常规急诊筛查头颅CTA/CTV,同时监测凝血功能;对于持续剧烈头痛症状且无法缓解的患者,应尽可能全切囊壁,同时避免囊内容物进一步扩散。

Objective To investigate the clinical,imaging findings,diagnosis and treatment experience of spontaneous rupture of intracranial epidermoid cyst complicated with venous sinus thrombosis.Methods The clinical data of a patient with spontaneous rupture of intracranial epidermoid cyst complicated with venous sinus thrombosis were analyzed retrospectively,and the relevant literature was reviewed.Results A 51 year old male patient presented with headache symptoms after rupture of epidermoid cyst.His condition progressed rapidly after admission.Venous sinus thrombosis was considered.Bilateral decompressive osteotomy was performed in the emergency.During the operation,the superior sagittal sinus was drilled in the midline and cut.The“earthworm like”long hematoma was sucked out with a micro aspirator,which was confirmed to be superior sagittal sinus venous sinus thrombosis.After operation,the patient was still in deep coma,GCS(1-T-1),ventilator assisted mechanical ventilation,bilateral mydriasis to the edge,and blood pressure needed to be maintained by high-dose norepinephrine.Conclusions For patients with ruptured intracranial epidermoid cyst with high risk factors of chemical encephalitis,it is necessary to routinely screen CTA/CTV and monitor coagulation function in the process of clinical diagnosis and treatment.For patients with persistent severe headache that can not be relieved,the capsule wall should be completely removed as far as possible,and further diffusion of capsule contents should be avoided.