桥小脑角区巨大肿瘤术后并发非术区硬膜外血肿

An Analysis on the Extradural Hematoma in Non-operative Regions after the Removal of Huge Tumors in Cerebellopontine Angle Region

目的:探讨桥小脑角区巨大肿瘤术后并发非术区硬膜外血肿的机制、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4所综合性医院共28例桥小脑角区巨大肿瘤术后并发非术区硬膜外血肿病人进行分析总结。结果:本组发病年龄较小,平均年龄34.4岁;发生于术后24 h内者占78.6％;有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>40 ml者占82.1％;所有患者术前均有不同程度脑积水;出血来源为导静脉、蛛网膜粒撕裂出血及剥离硬脑膜渗血。结论:多数为中年患者,多发生于术后24 h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,牵拉导静脉及蛛网膜粒使其撕裂而出血,血肿挤压硬脑膜使其剥离损伤表面血管而渗血,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 explore the mechanism, characteristics and the causes of extradural hema-toma in non-operative regions after the removal of huge tumors from cerebellopontine angle region. Methods: Data of 28 cases from native four hospitals were analyzed and summarized. Results: 1 ) Most patients were middle-aged persons(34. 4 years old on average). 78. 6% of the cases happened within 24 hours after operation. 85. 7% hematomas occurred in frontal, temporal, and parietal areas, and about 78. 6% of them located in the same side of tumors. Hematomas with the volume of more than 40 ml were found in 82. 1% of the cases. Moreover, hydrocephalus of different extents presented in all cases. Conclusion; 1) The disease mostly happen within 24 hours after operation; 2) Most hematomas with great volume are in the same side of frontal, temporal, or parietai areas; 3 ) Patients are mainly middle-aged. Further more, hydrocephalus existed is a common cause for this complication. Most experts consider that the quick changes of intracranial pressure and dynamics of cerebrospinal fluid cause col-lapse of brain tissue, laceration of venae emissaria or ( and ) arachnoidal granulations, and then, dura stripping and injury of superficial blood vessel, and this might be the mechanism.