桥小脑角区巨大肿瘤术后并发远隔硬膜外血肿

Analysis of Postoperative Remote Extradural Hematoma after the Removal of Huge Tumor in Cerebellopontine Angle

目的 :探讨桥小脑角区巨大肿瘤术后并发远隔硬膜外血肿的机制、特点及原因 ,以期提高对这一并发症的认识及预防 .方法 :对本地区四所综合性医院共 2 8例进行分析总结 .结果 :本组发病年龄较小 ,平均年龄 34 4岁 ;发生于术后 2 4h内者占 78 6 % ;85 7%的血肿位于额、颞、顶区 ,无单独位于枕区者 ,同侧占 78 6 % ;血肿量 >4 0mL者占 82 1% ;所有患者术前都有不同程度脑积水 ;出血来源为导静脉、蛛网膜粒撕裂及剥离硬脑膜渗血 .结论 :多数为中年患者 ,多发生于术后 2 4h内 ,大部分血肿位于同侧额颞顶区 ,且血肿量一般较大 ,术前已有阻塞性脑积水者为本并发症的易发因素 .手术前后颅内压及脑脊液急剧动力学改变 ,致脑组织塌陷牵拉硬脑膜外的导静脉及蛛网膜粒引起撕裂而出血 ,继而硬脑膜剥离渗血加重出血 ,为本病发生的可能机制 ;针对机制各环节采取预防措施是预防的关键 .

Objective: To discuss the mechanisms, characters and reasons of postoperative remote extradural hematoma after the removal huge tumor in cerebellopontine angle, and to know them more and to prevent them effectively. Methods: We analyzed 28 cases from 4 hospitals in our region. Results: Most of patients were middle-aged, average age was 34 4 years old. 78 6% cases happened within 24 hours after operation. The hematomas located at frontal temporal and parietal regions were about 85% and about 78 6% was in the same side of tumors. For 82 1% of them, the hematomas'volume was more than 40?mL . Moreover, hydrocephalus with different extents was presented in all cases. Conclusions: The complication happened in middle-aged patients and mostly within 24 hours after operation. We also found that most hematomas with greater volume is at the same side of tumors. Furthermore, obstructive hydrocephalus is a possible reason of the complication. Most experts considered that hematomas were caused by laceration of venae emissaria or/and arachnoidal granulations, and then dural stripped, since intracranial pressure dropped quickly and dynamics of cerebrospinal fluid changed sharply.