背景:综述颅内肿瘤切除术后硬膜外血肿(PEDH)的治疗方法和原因。
方法:进行了一项回顾性病例研究,以检查2016年1月至2021年6月期间颅内肿瘤切除术后发生PEDH并发症的一系列患者。这项研究从医院图表中收集数据,包括入院时的临床状况,成像结果,组织病理学发现,手术管理,并发症,和结果。通过回顾手术记录和与手术团队的讨论来评估PEDH的原因。
结果:25例患者(10例男性,15名女性;平均年龄42岁,范围11-61岁;中位病史27个月,范围1-96个月)纳入研究。关于肿瘤的位置,16例表现为幕上脑肿瘤,4例幕下脑肿瘤,2例肿瘤发生在岩斜区,周围区域2例,松果体区1例。其中4例并发幕上脑积水。这项研究中的25例病例根据位置分为四种类型。类型1是指发生在手术区域的邻近部位而不涉及手术区域的EDH。类型2包括发生在手术区域和手术区域的相邻部位的血肿。类型3包括在遥远地区发生的EDH,类型4涉及手术领域的EDH。1、2、3、4型PEDHs病例数分别为16、2、3、4例,分别。大多数PEDHs与开颅手术后ICP降低相关,原因是颅内肿瘤切除和脑脊液大量丢失。所有患者血肿清除术后均取得满意的疗效。
结论:颅内肿瘤切除引起的ICP降低和CSF丢失可能导致PEDHs。通过采用优化的手术技术和细致的患者管理,以防止ICP和硬脑膜脱离的快速下降,我们可以潜在地降低PEDHs的发病率。此外,迅速疏散血肿可以促进积极的结果。
BACKGROUND: To review the treatment and the causes of postoperative epidural hematoma (PEDH) after intracranial tumor resection.
METHODS: A retrospective
case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021. The study collected data from hospital charts, including clinical status at admission, imaging results, histopathologic findings, surgical management, complications, and outcomes. Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team.
RESULTS: Twenty-five patients (10 males, 15 females; median age 42 years, range 11-61 years; median medical history 27 months, range 1-96 months) were enrolled in the study. Regarding tumor location, 16 cases exhibited supratentorial brain tumors, 4 cases had infratentorial brain tumors, 2 cases of tumors occurred in the petroclival region, 2 cases in the peritorcular region, and 1
case in the pineal region. Four of these cases were complicated with supratentorial hydrocephalus. The 25 cases in this study were classified into four types based on location. Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area. Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area. Type 3 includes EDHs that occur in distant areas, and type 4 involves EDHs in the surgical field. The numbers of cases of types 1, 2, 3, and 4 PEDHs were 16, 2, 3, and 4 cases, respectively. Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF. All patients achieved satisfactory outcomes after hematoma evacuation.
CONCLUSIONS: The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs. By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment, we can potentially lower the incidence of PEDHs. Additionally, prompt evacuation of hematomas can contribute to positive outcomes.