背景:伽玛刀立体定向放射外科(GKRS)是公认的安全有效的脑转移治疗方法;然而,一些并发症可能带来重大的临床挑战.该病例报告强调了GKRS后罕见的脑脊液(CSF)渗漏和颅内积气,强调需要意识和及时管理这些并发症。
方法:2017年对一名35岁男性患者进行了GKRS治疗,该患者于2015年有唇部恶性肿瘤病史,恶性肿瘤经神经周围扩散至左侧海绵窦。患者因持续头痛和头晕在出院后39天紧急入院。
方法:脑计算机断层扫描(CT)显示弥漫性双侧气颅,同时观察到脑脊液渗漏。
方法:进行了包括左额颞部开颅术的外科手术,以切除残留的颅底肿瘤并修复硬脑膜,由导航仪系统引导。最终的病理评估显示存在鳞状细胞癌标志物。
结果:患者对整个手术表现出良好的耐受性,并经历了迅速而平稳的恢复过程。手术后,症状缓解,脑脊液漏停止。随访图像显示气颅消退。
结论:由于GKRS后早期引起的尘骨并不常见。肿瘤的快速缩小和脑转移通过硬脑膜扩散的时机可能导致CSF渗漏和颅内积气。我们回顾了当前的治疗方案,并介绍了成功的基于开颅手术的硬脑膜修复病例。
BACKGROUND: Gamma knife stereotactic radiosurgery (GKRS) is a recognized safe and effective treatment for brain metastasis; however, some complications can present significant clinical challenges. This
case report highlights a rare occurrence of cerebrospinal fluid (CSF) leakage and pneumocranium following GKRS, emphasizing the need for awareness and prompt management of these complications.
METHODS: A 35-year-old male with a history of malignant neoplasm of the lip in 2015 and perineural spread of malignancy into the left cavernous sinus was treated with GKRS in 2017. The patient was admitted emergently 39 days after discharge due to persistent headache and dizziness.
METHODS: Brain computed tomography (CT) revealed diffuse bilateral pneumocranium alongside an observation of CSF leakage.
METHODS: A surgical procedure involving a left frontal-temporal craniotomy was performed to excise a residual skull base tumor and repair the dura, guided by a navigator system. The conclusive pathological assessment revealed the presence of squamous cell carcinoma markers.
RESULTS: The patient exhibited excellent tolerance to the entire procedure and experienced a prompt and uneventful recovery process. After surgery, the symptoms alleviated and CSF leak stopped. The follow-up image showed the pneumocranium resolved.
CONCLUSIONS: Pneumocranium due to early-stage post-GKRS is uncommon. The rapid tumor shrinkage and timing of brain metastasis spreading through the dura can lead to CSF leak and pneumocranium. We reviewed current treatment options and presented a successful craniotomy-based dura repair
case.